Journal
JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY
Volume 27, Issue 10, Pages 1174-1179Publisher
WILEY-BLACKWELL
DOI: 10.1111/jce.13045
Keywords
cardiomyopathy; heart failure; pacing; pacing induced cardiomyopathy; right ventricular pacing
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Funding
- Richard T. and Angela Clark Innovation Fund in Cardiac Electrophysiology
- F. Harlan Batrus Research Fund
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Paced QRS and RV Pacing-Induced Cardiomyopathy IntroductionPacing-induced cardiomyopathy (PICM) is an important cause of heart failure in patients exposed to frequent right ventricular (RV) pacing. While echocardiography is diagnostic, the optimal surveillance strategy remains unknown. We sought to identify clinical and electrocardiographic factors associated with the presence of PICM to guide further testing. Methods and ResultsWe retrospectively studied 1,750 consecutive patients undergoing pacemaker implantation 2003-2012. Patients were included if baseline LVEF was normal, single chamber ventricular or dual chamber pacemaker (but not ICD or cardiac resynchronization therapy device) was implanted, frequent (20%) RV pacing was present and repeat echocardiogram was available following implantation. PICM was defined as 10% decrease in LVEF, resulting in LVEF <50%. Patients with alternative causes of cardiomyopathy were excluded. Clinical and electrocardiographic indicators of PICM were identified using multivariate logistic regression. Of 184 patients meeting study criteria, 42 (22.8%) developed PICM, with decrease in mean LVEF from 62.1% to 35.3% over mean follow-up 2.5 years. Longer follow-up paced QRS duration was associated with the presence of PICM (multivariate odds ratio 1.34 per 10 millisecond increase, 95% CI 1.06-1.63, p = 0.01). Paced QRS duration 150 milliseconds was 95% sensitive for PICM. Only half of patients with PICM had heart failure signs or symptoms at the time of echocardiographic diagnosis. ConclusionPatients with frequent RV pacing and paced QRS duration 150 milliseconds should be screened by echocardiogram to assess for PICM. Patients with paced QRS duration <150 milliseconds likely do not require screening, in the absence of heart failure signs or symptoms.
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