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Do the predictors of right ventricular pacing-induced cardiomyopathy add up?

Harsha Teja Perla1, Sirish Chandra Srinath Patloori1, Anand Manickavasagam1

  • 1Department of Cardiac Electrophysiology and Pacing, Christian Medical College, Vellore, India.

Indian Heart Journal
|October 10, 2021
PubMed

Insights

Pacing-induced cardiomyopathy (PICM) risk increases with lower baseline LVEF, longer paced QRS duration, and higher RV pacing burden. Two or more factors significantly elevate PICM odds, but a narrower paced QRS may reduce risk.

Area of Science:

  • Cardiology
  • Electrophysiology
  • Cardiomyopathy Research

Background:

  • Pacing-induced cardiomyopathy (PICM) is a growing concern in patients with pacemakers.
  • Understanding predisposing factors is crucial for risk stratification and prevention.

Purpose of the Study:

  • To determine the incidence of PICM in patients with preserved LVEF undergoing pacemaker implantation.
  • To identify independent predictors of PICM and assess their cumulative risk.

Main Methods:

  • Retrospective analysis of 749 patients with preserved LVEF who received pacemakers between 2012 and 2018.
  • Identification of risk factors including baseline LVEF, paced QRS duration, and RV pacing burden.

Main Results:

  • PICM developed in 9.9% of patients over a median follow-up of 2.2 years.
  • Independent predictors identified: baseline LVEF <55%, paced QRS duration >160 ms, and RV pacing burden >33%.
  • Patients with ≥2 risk factors had a 12-fold increased odds of developing PICM.

Conclusions:

  • Low-normal baseline LVEF, wider paced QRS, and higher RV pacing burden are significant predictors of PICM.
  • The cumulative effect of these risk factors substantially increases PICM development.
  • Optimizing paced QRS duration, a modifiable factor, may be key in mitigating PICM risk.
Abstract

Keywords:
Additive riskHeart failurePacing-induced cardiomyopathyRight ventricular pacingRisk factors

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