Adverse Effect of Ventricular Pacing on Heart Failure and Atrial Fibrillation Among Patients With Normal Baseline QRS Duration in a Clinical Trial of Pacemaker Therapy for Sinus Node Dysfunction

Abstract

Background-Dual-chamber (DDDR) pacing preserves AV synchrony and may reduce heart failure (HF) and atrial fibrillation (AF) compared with ventricular (VVIR) pacing in sinus node dysfunction (SND

2015 HRS/EHRA/APHRS/SOLAECE expert consensus statement on optimal implantable cardioverter-defibrillator programming and testing

“…In the Mode Selection Trial, which enrolled 2010 patients with sick sinus syndrome, the risk of AF increased linearly with the increasing percentage of RV pacing [30]. At the same time, deleterious effects of RV pacing in patients with LV dysfunction (left ventricular ejection fraction [LVEF] r40%) implanted with dual-chamber ICD systems were observed in the Dual Chamber and VVI Implantable Defibrillator (DAVID) trial, which included 506 ICD patients without indications for bradycardia pacing.…”

Benefits of Permanent His Bundle Pacing Combined With Atrioventricular Node Ablation in Atrial Fibrillation Patients With Heart Failure With Both Preserved and Reduced Left Ventricular Ejection Fraction

“…Options for pacing include pacing mode, such as RV pacing or biventricular pacing. Multiple clinical studies have demonstrated that long‐term RV apical pacing can lead to cardiac dysfunction and heart failure deterioration 4, 5, 6. A major mechanism of the detrimental effect of RV apical pacing is due to ventricular dyssynchrony caused by abnormal ventricular activation 4, 24.…”

“…However, several studies performed over the last decade have demonstrated that conventional long‐term RV apical pacing can increase the risk of death and heart failure hospitalization 4, 5, 6. It is well known that long‐term RV apical pacing produces wide QRS duration (QRSd), left ventricular (LV) dyssynchrony, hemodynamic impairment, negative inotropy, and LV diastolic and systolic dysfunction in a subgroup of pacer‐dependent patients 4, 7, 8.…”

Permanent Cardiac Pacing in Adults with High Grade Atriovetricular Block and Preserved Left Ventricular Function: Optimal Mode and Site of Pacing

“…The absence of significant change in resting LV ejection fraction with both septal and apical pacing in patients with ejection fraction >45% is probably attributable to the time needed for pacing-induced ventricular remodeling in that population. Sweeney et al (Sweeney et al, 2003) showed that in patients with normal LV systolic function without myocardial infarction, the risk of heart failure after RVA pacing was low. So RVA pacing may do little harm to patients with normal LV systolic function and RVOT pacing may have no benefit over RVA pacing for these patients (Cano et al, 2010).…”