Incidence and predictors of pacemaker-induced cardiomyopathy with right ventricular pacing: a systematic review

Abbas, Jawad; Zulqarnain, Muhammad; Waqar, Fatima; Waqar, Zain; Malik, Jahanzeb; Satti, Danish Iltaf; Zaidi, Syed Muhammad Jawad

doi:10.1080/14779072.2022.2062323

Cited by 5 publications

(6 citation statements)

References 35 publications

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“…The frequencies of PICM have been reported to be 5.1–26.8% at follow-up, with a mean period of 1–15 years 23 . The incidence rate of PICM in our study was 29.2% during a mean of 1.6 years of follow-up, which was slightly higher than that in many previous studies.…”

Section: Discussionmentioning

confidence: 99%

The estimated glomerular filtration rate predicts pacemaker-induced cardiomyopathy

Oida,

Hasumi,

Kohsaku

et al. 2023

Sci Rep

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Clinical predictors for pacemaker-induced cardiomyopathy (PICM) (e.g., a wide QRS duration and left bundle branch block at baseline) have been reported. However, factors involved in the development of PICM in patients with preserved left ventricular ejection fraction (LVEF) remain unknown. This study aimed to determine the risk factors for PICM in patients with preserved LVEF. The data of 113 patients (average age: 71.3 years; men: 54.9%) who had echocardiography before and after pacemaker implantation (PMI) among 465 patients undergoing dual-chamber PMI were retrospectively analyzed. Thirty-three patients were diagnosed with PICM (18.0/100 person-years; 95% CI 12.8–25.2). A univariate Cox regression analysis showed that an estimated glomerular filtration rate (eGFR) ≤ 30 mL/min/1.73 m2 (HR 3.47; 95% CI 1.48–8.16) and a past medical history of coronary artery disease (CAD) (HR 2.76; 95% CI 1.36–5.60) were significantly associated with the onset of PICM. After adjusting for clinical variables, an eGFR ≤ 30 mL/min/1.73 m2 (HR 2.62; 95% CI 1.09–6.29) and a medical history of CAD (HR 2.32; 95% CI 1.13–4.80) were independent risk factors for developing PICM. A medical history of CAD and low eGFR are independent risk factors for PICM in patients with preserved LVEF at baseline. These results could be helpful in predicting a decreased LVEF by ventricular pacing before PMI. Close follow-up by echocardiography is recommended to avoid a delay in upgrading to physiological pacing, such as cardiac resynchronization therapy or conduction system pacing.

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Section: Discussionmentioning

confidence: 99%

The estimated glomerular filtration rate predicts pacemaker-induced cardiomyopathy

Oida,

Hasumi,

Kohsaku

et al. 2023

Sci Rep

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“…Implantation of pacing device leads targeting initial activation of the right ventricle (RV) is a well-established therapeutic strategy for patients with bradyarrhythmia. However, patients who require frequent pacing via the RV lead are at risk of developing deleterious effects on left ventricular (LV) function, commonly termed pacing-induced cardiomyopathy (PICM) [1][2][3]. This, in turn, may also lead to challenging consequences such as increased appropriate therapies from implantable cardioverter defibrillators (ICDs) [4].…”

Section: Introductionmentioning

confidence: 99%

“…For example, pre-implant electrocardiogram (ECG) studies have demonstrated limited predicting power [6]. Meta-analyses have identified broader native QRS, reduced left ventricular ejection fraction (LVEF) at time of implant, or increased LV end diastolic diameter as predicting factors [3,7]. Other meta-analyses have found that older age or male sex contributes to PICM [3].…”

Section: Introductionmentioning

confidence: 99%

“…Meta-analyses have identified broader native QRS, reduced left ventricular ejection fraction (LVEF) at time of implant, or increased LV end diastolic diameter as predicting factors [3,7]. Other meta-analyses have found that older age or male sex contributes to PICM [3]. Importantly, higher RV pacing burdens of > 20% have been repeatedly found to be an independent predictor of PICM in multiple large studies [1,8].…”

Section: Introductionmentioning

confidence: 99%

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Optimizing Patient Selection for Physiological Pacing in Bradyarrhythmia: Factors Associated With High Ventricular Pacing Burden

Mannion,

Hong,

Hennessey

et al. 2024

Cardiol Res

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Background: Right ventricular (RV) pacing is established as the most common ventricular pacing (VP) strategy for patients with symptomatic bradyarrhythmia. Some patients with high VP burden suffer deterioration of left ventricular (LV) function, termed pacinginduced cardiomyopathy (PICM). Patients who pace > 20% of the time from the RV apex are at increased risk of PICM, but independent predictors of increased RV pacing burden have not been elucidated in those who have a permanent pacemaker (PPM) inserted for bradyarrhythmia. Methods:We aimed to identify factors that are associated with increased VP burden > 20%, hence determining those at risk for resultant PICM. In this retrospective cohort study, we identified the most recent 300 consecutive cardiac implantable electronic device (CIED) implants in our center and collected past medical history, electrocardiogram (ECG), echo, medication and pacemaker check data.Results: A total of 236 individuals met inclusion criteria. Of the patients, 35% had RV pacing burden < 20%, while 65% had VP burden ≥ 20%; 96.2% of patients with complete heart block (CHB) paced > 20% (P = 0.002). Utilization of DDD or VVI (75.2% and 89.2% of patients, respectively) without mode switch algorithms was associated with VP > 20% (P < 0.001). Male or previous coronary artery bypass grafting (CABG) patients also statistically paced > 20%. Other factors trending towards significance included prolonged PR interval, atrial fibrillation or more advanced age. Conclusion:High-grade atrioventricular (AV) block was associated with an RV pacing burden > 20% over 3 years but this was not consistent in patients with only transient episodes of high-grade AV block. We found a significant association between high VP% and male sex, previous CABG and the absence of mode switching algorithms.

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“…The placement of permanent pacemakers (PPMs) has become widely accepted in the management of bradyarrhythmia and is recommended by the current guidelines for the treatment of high-degree heart blocks and symptomatic bradycardia. In fact, approximately one million PPMs are implanted annually worldwide [1][2][3]. However, excessive right ventricle (RV) pacing was found to have been associated with the development of left ventricular (LV) systolic dysfunction.…”

Section: Introductionmentioning

confidence: 99%

Pacing-Induced Cardiomyopathy in Leadless and Traditional Pacemakers: A Single-Center Retrospective Analysis

Al-Asad¹,

Martínez²,

Prasad³

et al. 2023

Cureus

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Background: Pacing-induced cardiomyopathy (PICM) is a clinical syndrome that is characterized by a drop in the left ventricular ejection fraction (LVEF) due to chronic high-burden right ventricular (RV) pacing. It has been postulated that leadless pacemakers (LPs) cause decreased risk of PICM compared to transvenous pacemakers (TVPs), but the exact risk reduction is unknown. Methods: We performed a single-center retrospective analysis of adults who received an LP or TVP between January 1, 2014, and April 1, 2022, and had echocardiograms before and after the pacemaker implant. This study’s outcomes were the RV pacing percentage, change in EF, the need for cardiac resynchronization therapy (CRT) upgrade, and follow-up duration. A Wilcoxon rank-sum test calculated the change in EF. RV time, defined as the duration from pacemaker placement to the follow-up echocardiogram in months multiplied by the RV pacing percentage, served as a surrogate for how long the RV was paced. Results: A total of 614 patients were screened, and 198 patients were included in the study, where 72 received LP and 126 received TVP. The median follow-up was 480 days. The average of the reported RV percentage pacing was 63.43% for LP and 71.30% for TVP (p=0.14). The incidence of PICM and CRT upgrade was 44% and 9.7% in the LP group and 37% and 9.5% in the TVP group (p=0.3 and p>0.9), respectively. After accounting for age, sex, LP versus TVP, atrioventricular nodal ablation, RV pacing percentage, and follow-up duration, univariate analysis showed that RV time was significantly different between the two types of pacemakers (13.54 ± 14.21 months (LP) versus 9.26 ± 13.95 months (TVP), p=0.009). The difference in RV time between patients who underwent CRT upgrade and those who did not was statistically insignificant (12.11 ± 14.47 months (no CRT) versus 9.19 ± 12.00 months (CRT), p=0.5). Conclusions: This analysis demonstrated that the incidence of PICM was high in both groups (44% (LP) versus 37% (TVP)), despite significantly more RV time in patients with LP. There was no difference in CRT upgrade between LP and TVP.

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Incidence and predictors of pacemaker-induced cardiomyopathy with right ventricular pacing: a systematic review

Cited by 5 publications

References 35 publications

The estimated glomerular filtration rate predicts pacemaker-induced cardiomyopathy

The estimated glomerular filtration rate predicts pacemaker-induced cardiomyopathy

Optimizing Patient Selection for Physiological Pacing in Bradyarrhythmia: Factors Associated With High Ventricular Pacing Burden

Pacing-Induced Cardiomyopathy in Leadless and Traditional Pacemakers: A Single-Center Retrospective Analysis

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