Understanding Pacemaker-Induced Cardiomyopathy Incidence and Predictors in Patients with Right Ventricular Pacing: A Systematic Review

Abstract

This study aimed to figure out the incidence and predictors of pacemaker-induced cardiomyopathy (PICM) in patients with right ventricular (RV) pacing. We systematically searched in PubMed on March 18, 2020, for English language abstract and full-article journals, using the following criteria: pacemaker induced cardiomyopathy AND right ventricular AND pacemaker AND patients AND human NOT implantable cardioverter defibrillator NOT ICD NOT animal. Four studies were included in this review after filtering 35 studies through year of publication and abstract selection. The average PICM incidence from 1,365 patients included from the four studies was 10.7 to 13.7%. One study stated that preimplantation left ventricular ejection fraction (LVEF) was the predictor for the development of PICM. Three studies mentioned that RV pacing burden was the predictor for the development of PICM. However, the percentage differ in three studies: ≥20, >40, and 60%. In addition, one of the studies also included interventricular dyssynchrony as another predictor. The incidence of PICM in patients with RV pacing ranged from 10.7 to 13.7%. Preimplantation LVEF, interventricular dyssynchrony, and burden of RV pacing are reported as the predictors for the development of PICM in patients with RV pacing.

Correlation of ventricular pacing burden and left ventricular function in patients with heart failure with reduced ejection fraction

“…In comparison to patients with previously normal LV function, there was an overall trend towards improvement of LV function in patients with underlying cardiomyopathies following pacemaker implantation. Although this did not correlate with degree of RV pacing, the proportion of patients that had a significant fall in LV function following pacemaker implantation (17.2%) is higher than previously reported PICM rates of 5%–15% in those with baseline normal EF 1,2 . This likely reflects the often progressive nature of heart failure.…”

Pacemaker-induced cardiomyopathy

“…Each year, more than 700,000 new permanent pacemakers are implanted and more than 200,000 patients have permanent pacemakers replaced. 4 A prospective study by Carrión-Camacho and colleagues revealed that 1.25 million pacemakers are implanted every year worldwide. 9 RV apical pacing has been the only effective treatment of choice for symptomatic sinus node dysfunction and high-degree AV block.…”

“…Pacemaker-induced cardiomyopathy (PICM) is a new type of cardiomyopathy that has been recognized in recent years because of the increasing number of patients with permanent pacemakers and associated heart failure. According to Laksono and colleagues, studies have revealed that the incidence of PICM ranges from 10.7% to 13.7% 4. In addition, a recent study revealed that the incidence of PICM can develop in 5.9% to 39% of patients 3 to 4 years after pacemaker implantation 5.…”

“…Each year, more than 700,000 new permanent pacemakers are implanted and more than 200,000 patients have permanent pacemakers replaced 4. A prospective study by Carrión-Camacho and colleagues revealed that 1.25 million pacemakers are implanted every year worldwide 9.…”

“…to Laksono and colleagues, studies have revealed that the incidence of PICM ranges from 10.7% to 13.7%. 4 In addition, a recent study revealed that the incidence of PICM can develop in 5.9% to 39% of patients 3 to 4 years after pacemaker implantation. 5 Chronic right ventricular (RV) apical pacing has deleterious effects on the myocardium and results in the development of cardiomyopathy.…”