The Prevalence of Pacing-Induced Cardiomyopathy (PICM) in Patients With Long Term Right Ventricular Pacing − Is it a Matter Of Definition?

The desire for physiological pacing: Are we there yet?

“…29 In a prospective study (n = 118) with a mean follow up of 3.5 ± 1.4 years the incidence of PICM varied between 5.9 and 9.3% depending upon how PICM was defined. 30 This study also showed that in patients with preserved LVEF at baseline up to 39% showed a reduction in LVEF but not to a degree where this had become clinically significant, suggesting that reduction in LV function may be more common than thought. Intriguingly, 8.5% of patients in this study showed an improvement in LVEF following RVp.…”

“…A recent small‐scale study, comparing RVAp to His bundle pacing (HBP), showed a significant decline in LV function in 22% of the RVAp group over 5 years follow up in comparison to only 2% in the HBP arm . In a prospective study (n = 118) with a mean follow up of 3.5 ± 1.4 years the incidence of PICM varied between 5.9 and 9.3% depending upon how PICM was defined . This study also showed that in patients with preserved LVEF at baseline up to 39% showed a reduction in LVEF but not to a degree where this had become clinically significant, suggesting that reduction in LV function may be more common than thought.…”

The quest for physiological pacing—Does one size fit all?

“…This suggests that RV pacing impairs LVEF in many patients, even though the clinical criterion for PICM is not reached. 12 However, these data do not show that adverse effects will universally occur in all patients, and rather support the view that other factors apart from the pacing site, or pacing per se, compound or attenuate the propensity for RVAp to result in reduction in LVEF in individual patients.…”

“…Importantly it was also noted that up to 40% of patients had a reduction of more than 10% in ejection fraction (within the mean 3.4‐years study period) although not to a level consistent with cardiomyopathy (LVEF < 45%). This suggests that RV pacing impairs LVEF in many patients, even though the clinical criterion for PICM is not reached . However, these data do not show that adverse effects will universally occur in all patients, and rather support the view that other factors apart from the pacing site, or pacing per se, compound or attenuate the propensity for RVAp to result in reduction in LVEF in individual patients.…”

Network meta‐analysis of His bundle, biventricular, or right ventricular pacing as a primary strategy for advanced atrioventricular conduction disease with normal or mildly reduced ejection fraction

“…Frequent RV pacing may occasionally result in pacing‐induced cardiomyopathy (PICM), usually defined as drop in EF less than 40% after excluding other causes. PICM frequency varies from 5.9% to 39% of patients with RV pacing, 2,33, 34 depending on the definition used and the pacing burden, with higher prevalence in patients with more than 20% ventricular pacing 2 . It has been demonstrated that upgrade to BiV pacing is an effective treatment for PICM and can reverse the cardiomyopathy 35 .…”