Pacing induced cardiomyopathy: recognition and management

Ponnusamy, Shunmuga Sundaram; Syed, Thabish; Vijayaraman, Pugazhendhi

doi:10.1136/heartjnl-2022-321723

Cited by 16 publications

(5 citation statements)

References 58 publications

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“…We also evaluated the association between the FIB-4 index and cardiovascular death as a secondary outcome. As mentioned earlier, RVP may significantly affect left ventricular contraction and valvular pathology due to its nonphysiological pacing pattern, increasing the risk of heart failure and atrial fibrillation [1–3]. Considering that the FIB-4 index may reflect the pathophysiology of circulatory failure, we hypothesized that there would be a significant association between the FIB-4 index and cardiovascular death.…”

Section: Discussionmentioning

confidence: 99%

“…In the past, right ventricular pacing (RVP) was used for bradycardia arrhythmias; however, this was associated with problems like decreased left ventricular systolic function [1], increased hospitalization for heart failure [2], and the onset of atrial fibrillation [3] due to electrical and mechanical dyssynchrony. To address these issues, pacing techniques involving the His bundle or left bundle area have been recently introduced [4,5].…”

Section: Introductionmentioning

confidence: 99%

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Clinical value of the fibrosis-4 index in predicting mortality in patients with right ventricular pacing

Inoue,

Morikawa,

Ogane

et al. 2023

Preprint

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BackgroundThe fibrosis-4 (FIB-4) index has attracted attention as a predictive factor for cardiovascular events and mortality in patients with heart disease. However, its clinical value in patients with implanted pacemakers remains unclear.MethodsThis study included patients who underwent pacemaker implantation. The FIB-4 index was calculated based on blood tests performed during the procedure. The primary outcome was all-cause mortality, and secondary outcomes included cardiovascular and non-cardiovascular death. The FIB-4 index was stratified into tertiles. Between-group comparisons were performed using log-rank tests and multivariate analysis using Cox proportional hazards. The predictive accuracy and cut-off value of the FIB-4 index were calculated from the receiver operating characteristic curve for all-cause mortality.ResultsThis study included 201 participants, of whom 38 (incidence rate: 5.8/100 person-years) experienced death events during the observation period (median: 1097 days). All-cause and non-cardiovascular death differed significantly between groups stratified by the FIB-4 index tertiles (log-rank test:P<0.001 andP<0.001, respectively). Using Cox proportional hazards analysis, the unadjusted hazard ratio was 4.75 (95% confidence interval [CI]: 2.05–11.0,P<0.001) for Tertile 3 compared to Tertile 1. After adjustment for confounding factors, including age, sex, the presence or absence of left bundle branch block at baseline, QRS duration during pacing, and pacing rate at the last check, the hazard ratio was 3.61 (95% CI: 1.37–9.48,P=0.009). The cut-off of the FIB-4 index was 3.75 (area under the curve: 0.72, 95% CI: 0.62–0.82).ConclusionsThe FIB-4 index was a potential predictive factor for all-cause mortality in patients with implanted pacemakers.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Clinical value of the fibrosis-4 index in predicting mortality in patients with right ventricular pacing

Inoue,

Morikawa,

Ogane

et al. 2023

Preprint

View full text Add to dashboard Cite

show abstract

“…We also evaluated the association between the FIB-4 index and cardiovascular death as a secondary outcome. As mentioned earlier, RVP may significantly affect left ventricular contraction and valvular pathology due to its non-physiological pacing pattern, increasing the risk of heart failure and atrial fibrillation [ 1 – 3 ]. Considering that the FIB-4 index may reflect the pathophysiology of circulatory failure, we hypothesized that there would be a significant association between the FIB-4 index and cardiovascular death.…”

Section: Discussionmentioning

confidence: 99%

“…In the past, right ventricular pacing (RVP) was used for bradycardia arrhythmias; however, it was associated with problems such as decreased left ventricular systolic function [ 1 ], increased hospitalization for heart failure [ 2 ], and the onset of atrial fibrillation [ 3 ] due to electrical and mechanical dyssynchrony. To address these issues, pacing techniques involving the His bundle or the left bundle area have recently been introduced [ 4 , 5 ].…”

Section: Introductionmentioning

confidence: 99%

Clinical value of the fibrosis-4 index in predicting mortality in patients with right ventricular pacing

Inoue,

Morikawa,

Ogane

et al. 2024

PLoS ONE

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Background The fibrosis-4 (FIB-4) index has attracted attention as a predictive factor for cardiovascular events and mortality in patients with heart disease. However, its clinical value in patients with implanted pacemakers remains unclear. Methods This study included patients who underwent pacemaker implantation. The FIB-4 index was calculated based on blood tests performed during the procedure. The primary outcome was all-cause mortality, and the secondary outcomes included cardiovascular death, non-cardiovascular death, and major adverse cardiovascular events (MACE; composite of cardiovascular death, heart failure hospitalization, non-fatal myocardial infarction, and non-fatal stroke). The FIB-4 index was stratified into tertiles. Between-group comparisons were performed using log-rank tests and multivariate analysis using Cox proportional hazards. The predictive accuracy and cut-off value of the FIB-4 index were calculated from the receiver operating characteristic curve for all-cause mortality. Finally, based on the calculated cut-off values, the patients were divided into two groups for outcome validation and subgroup analysis. Results This study included 201 participants, of whom 38 experienced death during the observation period (median: 1097 days). All-cause mortality, non-cardiovascular death, and MACE differed significantly between groups stratified by the FIB-4 index tertiles (log-rank test: P<0.001, P<0.001, and P = 0.045, respectively). Using Cox proportional hazards analysis, the unadjusted hazard ratio was 4.75 (95% confidence interval [CI]: 2.05–11.0, P<0.001) for Tertile 3 compared to Tertile 1. After adjustment for confounding factors, including sex, the presence or absence of left bundle branch block at baseline, QRS duration during pacing, and pacing rate at the last check, the hazard ratio was 4.79 (95% CI: 2.04–11.2, P<0.001). The cut-off value of the FIB-4 index was 3.75 (area under the curve: 0.72, 95% CI: 0.62–0.82). Conclusions In patients with pacemakers, the FIB-4 index may be a predictor of early all-cause mortality, with a cut-off value of 3.75.

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“…Several studies have confirmed the ability of biventricular pacing to reverse the LV dilatation and dysfunction along with reduction in the severity of mitral regurgitation. 28 In a cohort of 69 PICM patients identified through systematic inclusion and careful screening for alternative causes of CM, CRT upgrade was associated with marked improvement in systolic function, with mean LVEF increasing from 29.3% to 45.2% and more than 70% achieved LVEF >35%. The benefits of CRT upgrade appear to be rapid, and most of LVEF improvement occurs within three months and more gradually over the remainder of the first year.…”

Section: Treatmentmentioning

confidence: 97%

Conduction Disturbances Leading to Heart Failure – What Clinicians Need to Know

Figueiredo¹,

Nunes²,

Neuenschwander³

et al. 2023

ABC Heart Fail Cardiomyop

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Recently, pre-excitation syndromes, left bundle branch block (LBBB), and right ventricular pacing have been recognized as causes of cardiomyopathies (CMs). They all have abnormal ventricular activation, that results in what is known as left ventricular (LV) dyssynchrony. These three entities show a common feature of wide QRS and LBBB pattern on the electrocardiogram. The term abnormal conduction-induced CM was, then, proposed. Appropriate diagnosis and treatment of these CMs will possibly improve LV ejection fraction, LV functional capacity and reduce morbidity and mortality. In this article we will briefly review these three clinical conditions, aiming to help clinicians to recognize them, manage and refer patients at risk.

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Pacing induced cardiomyopathy: recognition and management

Cited by 16 publications

References 58 publications

Clinical value of the fibrosis-4 index in predicting mortality in patients with right ventricular pacing

Clinical value of the fibrosis-4 index in predicting mortality in patients with right ventricular pacing

Clinical value of the fibrosis-4 index in predicting mortality in patients with right ventricular pacing

Conduction Disturbances Leading to Heart Failure – What Clinicians Need to Know

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