Incidence and predictors of heart failure hospitalization and death in permanent pacemaker patients: a single-centre experience over medium-term follow-up

The aim of this study was to assess the incidence and clinical predictors of the development of new-onset heart failure (HF) over medium-term follow-up, in patients treated with permanent pacing in daily clinical practice. We retrospectively enrolled all consecutive patients who underwent single- or dual-chamber pacemaker implantation at the study centre. Patients with a left ventricular ejection fraction (LVEF) 35 or a prior diagnosis of HF were excluded. Ventricular leads were routinely implanted in the right apex. Pacemakers were implanted in 490 patients with a standard pacemaker indication and LVEF 35. Left bundle-branch block (LBBB) was reported in 30 (8) patients, and an LVEF 50 in 64 (13) patients. During a follow-up of 27 21 months, 32 (7) patients reached the combined endpoint of HF death or hospitalization. On multivariate analysis, LBBB (HR, 3.50; 95 CI, 1.111.1; P 0.033) and LVEF 50 (HR, 5.1; 95 CI, 1.914.2; P 0.002) were confirmed as independent predictors of HF death or hospitalization. Patients with LVEF 50 and/or LBBB displayed significantly higher rates of HF death or hospitalization (log-rank test, all P0.001). The majority of patients with a standard indication for permanent pacing and normal LV function remained in a clinically stable condition after pacemaker implantation. However, 7 of patients developed new-onset HF over a period of follow-up of 27 months, and the presence of LBBB and LVEF 50 at the baseline predicted HF death or hospitalization.