Left ventricular dysfunction after pacemaker implantation: Who could benefit from upfront conduction system pacing?

Area of Science:

• Cardiology
• Electrophysiology
• Medical Device Technology

Background:

• Pacing-induced cardiomyopathy (PICM) is a known complication of pacemaker implantation.
• PICM is linked to poorer patient prognosis and adverse cardiovascular events.

Purpose of the Study:

• To evaluate the incidence and prognostic impact of PICM using various definitions.
• To develop a pre-implantation risk score for predicting PICM severity and associated adverse events.

Main Methods:

• Retrospective analysis of 678 patients with preserved ejection fraction undergoing pacemaker implantation.
• Utilized five literature-based definitions for PICM diagnosis and analyzed cardiovascular death or heart failure hospitalization as a composite endpoint.
• Developed and validated a multivariable logistic regression risk score incorporating pre-implantation parameters.

Main Results:

• PICM incidence varied from 5.0% to 19.6% depending on the definition used.
• PICM significantly increased the risk of the composite endpoint (HR 3.23-5.23), with severity correlating to outcome.
• The developed risk score demonstrated good predictive accuracy (AUC 0.710) for PICM and adverse events.

Conclusions:

• Stricter PICM definitions identify higher-risk patient subgroups.
• A validated risk score can predict PICM occurrence and inform the use of preventive conduction system pacing.
• Risk stratification may optimize pacemaker implantation decisions, potentially preventing overtreatment and improving outcomes.