Ventricular remodeling in right ventricular apical pacing

Area of Science:

• Cardiology
• Cardiac Electrophysiology
• Medical Device Technology

Background:

• Right ventricular apical pacing (RVAP) is a common pacing strategy for complete atrioventricular block (CAVB).
• The potential for RVAP to induce ventricular remodeling (VR) in patients with preserved baseline cardiac function requires investigation.
• Understanding factors influencing VR is crucial for optimizing pacing strategies and patient outcomes.

Purpose of the Study:

• To assess the incidence of ventricular remodeling (VR) in patients with normal baseline cardiac function undergoing RV apical pacing (RVAP).
• To identify clinical and functional variables associated with the development of VR after RVAP.

Main Methods:

• A cohort of 75 patients with CAVB and preserved left ventricular ejection fraction (LVEF) and left ventricular end-diastolic diameter (LVEDD) were included.
• Ventricular remodeling was defined by echocardiographic changes (LVEDD increase >10%, LVEF decrease >20%) at least six months post-implantation.
• Clinical data including heart disease, NYHA class, pacing duration, and QRS duration were analyzed.

Main Results:

• The mean follow-up duration was 80.2 months.
• A low rate of ventricular remodeling (5.3%) was observed in the study population.
• No significant association was found between baseline characteristics, pacing parameters, and the development of VR.

Conclusions:

• Long-term RV apical pacing in patients without pre-existing ventricular dysfunction is associated with a low incidence of ventricular remodeling.
• No specific clinical or functional variable reliably predicted the occurrence of VR in this patient group.
• These findings suggest that RVAP may be a safe pacing option regarding ventricular remodeling in selected patients.