Incidence and Predictors of Pacing-Induced Cardiomyopathy in Paced Patients Undergoing Attempted Left Bundle Branch
Katsuhide Hayashi1,2, Aritra Paul1, Roy Chung1
1Cardiac Electrophysiology and Pacing Section, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA.
Insights
Pacing-induced cardiomyopathy (PICM) is uncommon in patients undergoing left bundle branch area pacing (LBBAP). Successful LBBAP is linked to a lower risk of PICM, highlighting its protective effect.
Area of Science:
- Cardiology
- Electrophysiology
- Cardiomyopathy Research
Background:
- Pacing-induced cardiomyopathy (PICM) incidence and predictors remain unclear for left bundle branch area pacing (LBBAP).
- Understanding these factors is crucial for patients with preserved ejection fraction and atrioventricular block.
Purpose of the Study:
- To determine the incidence of PICM in patients with preserved left ventricular ejection fraction (LVEF) and atrioventricular block (AVB) undergoing attempted LBBAP.
- To identify predictors of PICM in this patient population.
Main Methods:
- A cohort of 173 patients with preserved LVEF and AVB undergoing attempted LBBAP (2018-2022) was analyzed.
- PICM was defined by a significant decrease in LVEF post-pacemaker implantation.
- Multivariate analysis identified independent predictors of PICM.
Main Results:
- The incidence of PICM was 7.5% (13/173 patients).
- Successful LBBAP (68.2% of patients) was associated with a significantly lower PICM incidence compared to non-LBBAP.
- Non-LBBA capture and lower pre-implant LVEF were independent predictors of PICM.
Conclusions:
- LBBAP in patients with AVB and preserved LVEF is associated with a low incidence of PICM.
- Achieving LBBA capture appears to be protective against the development of PICM.
Background:
The incidence and predictors of pacing-induced cardiomyopathy (PICM) in patients undergoing attempted left bundle branch area pacing (LBBAP) are unknown.
Objective:
To examine the incidence and predictors of PICM in patients with preserved left ventricular ejection fraction (LVEF) and atrioventricular block (AVB) undergoing attempted LBBAP.
Methods:
The study cohort included consecutive patients undergoing an attempt at LBBAP at the Cleveland Clinic from 2018 until 2022 with preserved LVEF and AVB. PICM was defined as post-PM LVEF decrease to < 50% and > 5%, > 10% decrease from pre-PM implantation. Patients who had alternative reasons for a decrease in LVEF during follow-up were excluded. LBBAP was defined as meeting common criteria for LBBAP and the incidence of PICM was evaluated.
Results:
A total of 173 patients were included. PICM developed in 13/173 (7.5%) of patients at 26 (IQR 7-70) weeks after PM implantation. In total, 12 (6.9%) patients experienced LVEF > 10% decrease. Of 173 patients, 118 (68.2%) patients met criteria for LBBAP. The LBBAP group had a significantly lower incidence of PICM compared with the non-LBBAP group (log rank p = 0.048). The optimal V6RWPT for predicting PICM was 80 ms and the incidence of PICM increased in proportion to the increase in V6RWPT. In multivariate analysis, non-LBBA capture (HR: 5.58, 95% CI: 1.46-24.32; p = 0.01) and LVEF at pre-PM implant per 10% (HR: 0.11, 95% CI: 0.02-0.40; p = 0.0003) were independent predictors for the development of PICM.
Conclusion:
The incidence of PICM with LBBAP in paced patients undergoing PM implant with AVB and preserved LVEF is low. LBBA capture was associated with freedom from PICM.
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