Predictors of pacing-dependency in patients with cardiovascular implantable electronic devices

Background: Data on the prevalence and predictors for the development of pacing-dependency in patients with cardiovascular implantable electronic devices (CIEDs) are sparse. Methods: Pacing-dependency defined as an absence of intrinsic rhythm of >= 30 bpm was determined in 802 consecutive patients with CIEDs who visited the documented pacemaker or implantable cardioverter-defibrillator outpatient clinic for routine follow-up. Results: A total of 131 (16%) patients were found to be pacing-dependent 67 +/- 70 months after CIED implant. Multivariate analysis revealed a significant association between pacing-dependency and the following clinical variables: second or third-degree atrioventricular (AV) block at implant (OR = 19.9; 95% CI: 10.9-38.5, p < 0.01), atrial fibrillation at implant (OR = 2.15; 95% CI: 1.16-4.05, p = 0.02), left ventricular ejection fraction (LVEF) = 30% (OR = 2.06; 95% CI: 1.03-4.15, p = 0.04), B-type natriuretic peptide (BNP) > 150 pg/mL (OR = 2.12; 95% CI: 1.16-3.97, p = 0.02), chronic kidney disease (OR = 1.86; 95% CI: 1.08-3.26, p = 0.03), and follow-up duration after implantation > 5 years (OR = 3.29; 95% CI: 1.96-5.64, p < 0.01). None of the remaining clinical variables including age, gender, diabetes mellitus, underlying heart disease, prior cardiac surgery or medication during follow-up including beta-blockers and amiodarone predicted pacing-dependency. Conclusions: Pacing-dependency is associated with second or third-degree AV-block at implant, atrial fibrillation before implant, low LVEF, elevated BNP, chronic kidney disease and follow-up duration after implant.

Automated summary

The study showed that pacing-dependency in patients with CIEDs is significantly associated with factors such as second or third-degree AV block, atrial fibrillation at implant, low LVEF, elevated BNP, chronic kidney disease, and follow-up duration after implantation exceeding 5 years. Other clinical variables like age, gender, diabetes mellitus, underlying heart disease, prior cardiac surgery, and medication during follow-up did not predict pacing-dependency.