Pacing-induced cardiomyopathy: A narrative review

Area of Science:

• Cardiology
• Biomedical Engineering

Background:

• Pacemaker implantation rates are rising globally.
• Chronic right ventricular pacing (RVP) can cause pacing-induced cardiomyopathy (PICM), leading to heart failure.
• Identifying patients at high risk for PICM is challenging.

Purpose of the Study:

• To review literature on PICM definitions, pathophysiology, prevalence, risk factors, screening, and treatments.
• To explore strategies for preventing PICM through early intervention.
• To aid in identifying suitable candidates for de novo cardiac resynchronization therapy (CRT) or cardiac physiologic pacing.

Main Methods:

• A narrative literature review was conducted.
• Pertinent studies on PICM in adult populations were examined.
• Focus on definitions, pathophysiology, prevalence, risk factors, screening tools, and treatment options.

Main Results:

• PICM is a complication of RVP causing adverse cardiac remodeling and left ventricular dysfunction.
• Prevalence assessment is hindered by variability in lead sites and pacing options.
• Effective risk stratification using patient characteristics is crucial.

Conclusions:

• Early identification of high-risk patients is essential for preventing PICM.
• Cardiac physiologic pacing and CRT are key preventative and treatment strategies.
• Improved risk assessment can guide timely interventions to prevent pathologic remodeling.