Incidence of heart failure after pacemaker implantation: a nationwide Danish Registry-based follow-up study

Abstract

Aims The objective of the current study is to investigate the risk of heart failure (HF) after implantation of a pacemaker (PM) with a right ventricular pacing (RVP) lead in comparison to a matched cohort without a PM and factors associated with this risk. Methods and results All patients without a known history of HF who had a PM implanted with an RVP lead between 2000 and 2014 (n = 27 704) were identified using Danish nationwide registries. An age- and gender-matched control cohort (matched 1:5, n = 138 520) without PM and HF was identified to compare the risk. Outcome was the cumulative incidence of HF including fatal HF within the first 2 years of PM implantation, with all-cause mortality and myocardial infarction (MI) as competing risks. Due to violation of proportional hazards, the follow-up period was divided into three time-intervals: <30 days, 30–180 days, and >180 days–2 years. The cumulative incidence of HF including fatal HF was observed in 2937 (10.6%) PM patients. Risks for the three time-intervals were <30 days [hazard ratio (HR) 5.98, 95% CI 5.19–6.90], 30–180 days (HR 1.84, 95% CI 1.71–1.98), and >180 days (HR 1.11, 95% CI 1.04–1.17). Among patients with a PM device, factors associated with increased risk of HF were male sex (HR 1.33, 95% CI 1.24–1.43), presence of chronic kidney disease (CKD) (HR 1.64, 95% CI 1.29–2.09), and prior MI (1.77, 95% 1.50–2.09). Conclusions Pacemaker with an RVP lead is strongly associated with risk of HF specifically within the first 6 months. Patients with antecedent history of MI and CKD had substantially increased risk.

The desire for physiological pacing: Are we there yet?

“…Meta‐analysis also suggests that the longer the period of pacing the more likely LV dysfunction will occur . In contrast a recent publication suggested that clinical heart failure occurred as early as within 30 days . Overall the data is not consistent but in the main the longer the pacing duration the more likely PICM will occur.…”

“…Intriguingly, 8.5% of patients in this study showed an improvement in LVEF following RVp. A recent observational registry study of 35,389 patients implanted with an RV lead showed a cumulative incidence of heart failure (HF), including fatal HF, in 10.6% …”

“…In the DAVID study most patients (more than 80%) suffered coronary artery disease, a process with known long‐term ongoing effects on LV function . A recent publication showed that factors which increased the risk of PICM included male sex, chronic kidney disease, and a prior myocardial infarction …”

“…19 A recent publication showed that factors which increased the risk of PICM included male sex, chronic kidney disease, and a prior myocardial infarction. 31 Overall it is likely that co-morbidities such as diabetes, systemic hypertension, and ischaemic heart disease, common to many paced patients, will have ongoing additive deleterious effects on LV function but more data are required about whether, and how much, specific co-morbidities alter outcome from pacing. 102 It is reasonable to suggest that inadequately managed co-morbidities are additional risk factors promoting continued deterioration in LV function.…”

“…A recent observational registry study of 35,389 patients implanted with an RV lead showed a cumulative incidence of heart failure (HF), including fatal HF, in 10.6%. 31 PICM is by no means universal. A large scale, prospective randomized study is required to accurately determine the true incidence of PICM but, overall, available data suggests an incidence of around 5 to 20%.…”