Left Ventricular Volumes and Systolic Function After Long-term Right Ventricular Pacing May be Predicted by Paced QRS Duration, but not Pacing Site

Chan, Ngai‐Yin; Yuen, Ho-Chuen; Choy, Chi-Chung; Mok, Ngai-Shing; Tsui, Ping-Tim; Lau, Chun-Leung; Lo, Ying-Keung; Chu, Pui-Shan; Chow, H.B.

doi:10.1016/j.hlc.2013.04.122

Cited by 8 publications

(8 citation statements)

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“…Supporting the results of this study, SPICE ECG and several smaller investigations consistently demonstrated that shorter pQRS duration correlated with septal and RV outflow tract pacing [[9], [10], [11], [12],18]. A shorter TPC and the absence of pID in lead aVL were both stronger predictors of septal pacing location in this study than pQRS which has been evaluated by other trials.…”

Section: Discussionsupporting

confidence: 88%

“…Several studies have demonstrated higher rates of incident left ventricular systolic dysfunction in RV paced patients with a prolonged pQRS – an association which was corroborated by the findings of this study. Likely due to differences in study design and definitions of systolic dysfunction, threshold pQRS durations for significance have varied widely from 130 to 180 ms [[15], [16], [17], [18], [19]]. The largest of these studies, a prospective trial of 194 patients with RV apical pacing, found that a pQRS duration of ≥165 ms had a sensitivity of 79% for development of pacemaker-induced cardiomyopathy over 5 years [19].…”

Section: Discussionmentioning

confidence: 99%

“…The ECG also has shown potential for providing prognostic information in patients with RV pacing. Several studies have shown that long pQRS duration is linked to the future development of left ventricular (LV) systolic dysfunction and clinical heart failure in patients who have no evidence of these complications at baseline [[14], [15], [16], [17], [18], [19]]. Other ECG parameters which assess the myocardial activation sequence with pacing have not been widely studied.…”

Section: Introductionmentioning

confidence: 99%

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Paced QRS morphology predicts incident left ventricular systolic dysfunction and atrial fibrillation

Zyl

Witt

Bhatia

et al. 2019

Indian Pacing and Electrophysiology Journal

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Background The prognostic significance of paced QRS complex morphology on surface ECG remains unclear. This study aimed to assess long-term outcomes associated with variations in the paced QRS complex. Methods Adult patients who underwent dual-chamber pacemaker implantation with 20% or more ventricular pacing and a 12-lead ECG showing a paced complex were included. The paced QRS was analyzed in leads I and aVL. Long-term clinical and echocardiographic outcomes were compared at 5 years. Results The study included 844 patients (43.1% female; age 75.0 ± 12.1). Patients with a longer paced QRS (pQRS) duration in lead I had a lower rate of atrial fibrillation (HR 0.80; p = 0.03) and higher rate of systolic dysfunction (HR 1.17; p < 0.001). Total pacing complex (TPC) duration was linked to higher rates of ICD implantation (HR 1.18; p = 0.04) and systolic dysfunction (HR 1.22, p < 0.001). Longer paced intrinsicoid deflection (pID) was associated with less atrial fibrillation (HR 0.75; p = 0.01), more systolic dysfunction (HR 1.17; p < 0.001), ICD implantation (HR 1.23; p = 0.04), and CRT upgrade (HR 1.23; p = 0.03). Exceeding thresholds for TPC, pQRS, and pID of 170, 146, and 112 ms in lead I, respectively, was associated with a substantial increase in systolic dysfunction over 5 years (p < 0.001). Conclusions Longer durations of all tested parameters in lead I were associated with increased rates of left ventricular systolic dysfunction. ICD implantation and CRT upgrade were also linked to increased TPC and pID durations. Paradoxically, patients with longer pID and pQRS had less incident atrial fibrillation.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Paced QRS morphology predicts incident left ventricular systolic dysfunction and atrial fibrillation

Zyl

Witt

Bhatia

et al. 2019

Indian Pacing and Electrophysiology Journal

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“… 3 15 In the PROTECT-PACE study, among patients with a high-grade AV block and preserved LV function, RV non-apical pacing did not have a protective effect on LV function compared with RV apical pacing over a 2-year period. 8 In addition, Chan et al 16 have previously reported that LV volumes and systolic function after long-term RV pacing could be predicted by pQRSd, but not pacing site. Our multicentre study also showed no significant difference between RV apical and non-apical pacing in the occurrence of PICM (40.4% vs 33.3%, P=0.546) among patients with CAVB with pacing-dependent rhythm over a long-term follow-up period.…”

Section: Discussionmentioning

confidence: 99%

Major determinant of the occurrence of pacing-induced cardiomyopathy in complete atrioventricular block: a multicentre, retrospective analysis over a 15-year period in South Korea

et al. 2018

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ObjectivesThe predictors of pacing-induced cardiomyopathy (PICM) for complete atrioventricular block (CAVB) have not yet been defined. The aim of this study was to investigate the major determinant of the occurrence of PICM.SettingThis is a multicentre, retrospective analysis of CAVB from tertiary referral centres in Daejeon, South Korea.ParticipantsA cohort of 900 consecutive patients with an implanted pacemaker was collected from December 2001 to August 2015. Of these, a total of 130 patients with CAVB with pacing-dependent rhythm who underwent ECG and echocardiogram before and after implantation were analysed for the occurrence of PICM.Outcome measuresCox proportional hazards models evaluated the determinant of PICM by ECG, device parameters and echocardiogram over a mean of 4.5 years.ResultsPICM was observed in 16.1% (n=21) of all patients with CAVB (age, 64±11 years; male, 36.2%). The preimplant left ventricular (LV) ejection fraction (66%±9% vs 66%±8%) and non-apical pacing (40.4% vs 33.3%) were similar; however, the native QRS duration (124±34 ms vs 149±32 ms) and the paced QRS duration (pQRSd) (139±29 ms vs 167±28 ms) were significantly different between the two groups. The postimplant LV ejection fraction (61%±7% vs 31%±8%) was also significantly different at the end of follow-up. A pQRSd significantly correlated with PICM (HR 1.05, 95% CI 1.02 to 1.09, P=0.001). A pQRSd with a cut-off value of above 140 ms had a sensitivity of 95% while a pQRSd with a cut-off value of above 167 ms had a specificity of 90% for PICM.ConclusionIn patients with CAVB with pacing-dependent rhythm, regardless of the pacing site, the pQRSd is a major determinant of the occurrence of PICM.

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“…Similar to our findings Chan et alreported that LV volume and systolic function are better predicted by pQRSd and not the pacing site, with pQRSd being a target for pacing site optimisation. 22 …”

Section: Discussionmentioning

confidence: 99%

Do the predictors of right ventricular pacing-induced cardiomyopathy add up?

Perla

Patloori

Manickavasagam

et al. 2021

Indian Heart Journal

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Objective Knowledge of factors causing pacing-induced cardiomyopathy (PICM) is incomplete. We sought to estimate the incidence and predisposing factors for PICM and evaluate if the risk they portend adds up. Methods Single centre retrospective study where consecutive patients with preserved LVEF undergoing pacemaker (PM) implantation between 2012 and 2018 were analysed. Results A total of 749 patients (68.4 % male; mean age 59.2 ± 14.08 years) were included in the analysis. PICM developed in 74 (9.9%) patients over a median follow up of 2.2 years (IQR 1.1–3.2). Pre-implant LVEF, paced QRS duration and RV pacing burden were independent predictors of PICM. Using 90 % specificity cut-off values for LVEF and paced QRS, and the value separating lowest tertile of RV pacing from the higher tertiles, three risk factors were identified: (i) baseline LVEF < 55 %, (ii) paced QRS duration > 160 msec, and (iii) RV pacing burden > 33 %. Patients with two or more risk factors were at the highest risk (OR 11.62, 95 % CI 4.62–29.21, p -value < 0.001) for developing PICM while those with one risk factor had an intermediate risk (OR 3.89, 95 % CI 1.62–9.34, p -value 0.002) when compared to those without any risk factors. Conclusion Low-normal baseline LVEF, wider paced QRS and higher RV pacing burden independently predicted the development of PICM. The presence of ≥2 factors increased the odds of PICM, twelve-fold. A narrower paced QRS, the only modifiable risk factor may help mitigate development of PICM.

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Left Ventricular Volumes and Systolic Function After Long-term Right Ventricular Pacing May be Predicted by Paced QRS Duration, but not Pacing Site

Cited by 8 publications

References 25 publications

Paced QRS morphology predicts incident left ventricular systolic dysfunction and atrial fibrillation

Paced QRS morphology predicts incident left ventricular systolic dysfunction and atrial fibrillation

Major determinant of the occurrence of pacing-induced cardiomyopathy in complete atrioventricular block: a multicentre, retrospective analysis over a 15-year period in South Korea

Do the predictors of right ventricular pacing-induced cardiomyopathy add up?

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