[Cardiac remodelling and function after cardiovascular implantable electronic devices implantation]

Area of Science:

• Cardiology
• Biomedical Engineering

Background:

• Cardiovascular implantable electronic devices (CIED), including pacemakers (PM) and implantable cardioverter-defibrillators (ICD), are crucial for managing cardiac arrhythmias.
• Conventional right ventricular (RV) pacing can lead to valvular defects, adverse cardiac remodeling, and reduced left ventricular ejection fraction due to lead-induced mechanical stress and electromechanical dyssynchrony.

Purpose of the Study:

• To review the potential complications associated with conventional CIED lead placement and pacing.
• To explore alternative CIED technologies that may mitigate these adverse effects.

Main Methods:

• Literature review of studies on CIED complications and novel pacing strategies.
• Analysis of the mechanisms underlying RV pacing-induced cardiac dysfunction.
• Evaluation of emerging CIED technologies like leadless pacemakers and subcutaneous ICDs.

Main Results:

• RV endocardial leads can cause tricuspid and mitral valve dysfunction, cardiac remodeling, and reduced ejection fraction.
• Lead adherence and fibrosis of valve leaflets are potential complications.
• Right ventricular pacing induces cardiac electromechanical dyssynchrony.
• Leadless pacemakers, His bundle pacing, and biventricular pacing show promise in reducing RV pacing complications.
• Subcutaneous ICDs may avoid lead-related complications associated with transvenous ICDs.

Conclusions:

• Conventional RV pacing strategies carry risks of cardiac damage and dysfunction.
• Emerging CIED technologies offer potential advantages by minimizing or avoiding lead-related complications and improving cardiac synchrony.