Incidence and Time Course for Developing Heart Failure With High-Burden Right Ventricular Pacing
Faisal M Merchant1, Michael H Hoskins2, Dan L Musat2
1From the Cardiology Division, Emory University School of Medicine, Atlanta, GA (F.M.M., M.H.H.); Cardiology Division, Valley Health System, Ridgewood, NJ (D.L.M., S.M.); and Abbott, Sunnyvale, CA (J.B.P., G.J.R., Y.N.). faisal.merchant@emory.edu.
Circulation. Cardiovascular Quality and Outcomes
|June 21, 2017
Summary
Patients with complete atrioventricular block (cAVB) receiving pacemakers face a higher risk of developing heart failure (HF) after implantation. This risk is particularly pronounced in younger patients and those with prior atrial fibrillation.
Area of Science:
- Cardiology
- Electrophysiology
- Heart Failure Research
Background:
- Right ventricular pacing is a known contributor to cardiomyopathy.
- The specific impact of complete atrioventricular block (cAVB) on heart failure (HF) development in pacemaker patients requires further characterization.
Purpose of the Study:
- To evaluate the incidence and time course of heart failure (HF) development in patients following pacemaker implantation for complete atrioventricular block (cAVB).
Main Methods:
- Utilized the MarketScan database (2008-2014) to identify patients undergoing dual-chamber pacemaker implantation.
- Dichotomized patients into groups with and without cAVB, requiring at least one year of enrollment pre- and post-implantation without prior HF diagnosis.
- Assessed new-onset HF in acute (0-6 months) and chronic (6 months to 4 years) phases post-pacemaker implantation.
Main Results:
- The study included 6,994 patients with cAVB and 14,208 without, followed for a median of 2.35 years.
- Patients with cAVB showed a significantly increased risk of new-onset HF in the acute phase (HR, 1.62) and chronic phase (HR, 1.16) post-pacemaker implantation.
- Younger patients (≤55 years) and those with a history of atrial fibrillation had the highest risk of HF associated with cAVB.
Conclusions:
- Complete atrioventricular block (cAVB) is associated with an elevated risk of new-onset heart failure (HF) after pacemaker implantation, likely due to increased right ventricular pacing.
- There is a need for improved methods to identify high-risk patients for HF development during right ventricular pacing.
- Further research should investigate the potential benefits of upfront biventricular pacing for these high-risk individuals.
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