Effect of Medical Therapy on Reducing the Risk of Pacing-Induced Cardiomyopathy

High right ventricular pacing burden can result in pacing-induced cardiomyopathy (PICM). The goal of this study was to investigate whether angiotensin-converting enzyme inhibitors (ACEI), angiotensin receptor blockers (ARB), and β-blockers (BB) are associated with a reduction in risk of PICM in patients with high right ventricular pacing burden.

This was a single-center, retrospective study that included patients with normal ejection fraction and complete heart block who underwent pacemaker implantation. The medical therapy group included patients who received ACEI/ARB, BB, or both. The control group received neither ACEI/ARB nor BB. The primary end point was PICM, defined as upgrade to a biventricular device or reduction in ejection fraction to ≤40% without another cause identified. Fine-Gray subdistribution hazard models were used to determine the relationship between medical therapy and cumulative incidence of PICM.

The study included 642 patients (mean±SD age, 71±14 years; 51% women). Over 10 years of follow-up, 76 (11.8%) received ACEI/ARB only; 49 (7.6%) received BB only, and 86 (13.4%) received both. PICM occurred in 10 of 211 in the medical therapy group (4.7%) and in 30 of 431 in the control group (7.0%). In adjusted weighted analyses, the risk of PICM was significantly lower in the medical therapy group compared with the control group (hazard ratio [HR], 0.59 [95% CI, 0.45-0.77]). Patients on combination therapy had the lowest risk (HR, 0.46 [95% CI, 0.31-0.69]).

Patients with high right ventricular pacing burden who received ACEI, ARB, or BB within 10 years of pacemaker implantation had a lower incidence of PICM.