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Tachycardia-Induced Cardiomyopathy As a Chronic Heart Failure Model in Swine
Published on: February 17, 2018
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Pacing induced cardiomyopathy: recognition and management.
Shunmuga Sundaram Ponnusamy1, Thabish Syed1, Pugazhendhi Vijayaraman2
1Division of Cardiology, Velammal Medical College Hospital and Research Institute, Madurai, Tamil Nadu, India.
Heart (British Cardiac Society)
|March 29, 2023
Summary
Right ventricle apex pacing is standard but can cause heart muscle damage (pacing-induced cardiomyopathy). Alternative pacing methods like conduction system pacing may reduce this risk and potentially reverse damage.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Device Technology
Background:
- Right ventricle (RV) apex pacing is the conventional method due to implantation ease and safety.
- RV pacing can lead to electrical and mechanical dyssynchrony, causing adverse left ventricular (LV) remodeling.
- This remodeling increases risks of heart failure (HF) hospitalization, arrhythmias, and mortality.
Purpose of the Study:
- To review the definition, prevalence, risk factors, and management of pacing-induced cardiomyopathy (PIC).
- To compare the risks of PIC with RV pacing versus alternative pacing strategies.
- To explore the potential of alternative pacing to reverse PIC.
Main Methods:
- Literature review and synthesis of existing studies on RV pacing and PIC.
- Analysis of definitions and reported prevalence of PIC.
- Identification and summary of risk factors associated with PIC development.
- Evaluation of evidence for conduction system pacing (CSP) and biventricular pacing in PIC prevention and reversal.
Main Results:
- Pacing-induced cardiomyopathy is defined by reduced left ventricular ejection fraction (LVEF) and/or new-onset HF or atrial fibrillation (AF) post-implantation.
- Pooled prevalence of PIC ranges from 6% to 25%, with an overall estimate of 12%.
- Risk factors include male sex, chronic kidney disease, prior myocardial infarction, baseline LVEF, QRS duration, and RV pacing burden.
- Conduction system pacing (His bundle, left bundle branch) may lower PIC risk compared to RV pacing.
- Biventricular pacing and CSP show potential for reversing PIC.
Conclusions:
- While RV apex pacing remains standard, its potential to induce cardiomyopathy necessitates consideration of alternative sites.
- Conduction system pacing offers a promising alternative to mitigate PIC risk.
- Both biventricular pacing and CSP may be effective in managing and reversing pacing-induced cardiomyopathy.
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