Kardiologia polska · 2025
Cardiac pacemakers and implantable cardioverter-defibrillators without cardiac resynchronization capability: Impact on cardiac function in a median follow-up of 1-year.
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Stanek Adrian, Ziobro Michał, Grądzka Wiktoria, Postel Linda, Matusik Patrycja S, Król Rafał, Pac Agnieszka, Lelakowski Jacek, Matusik Paweł T
Аннотация
BACKGROUND: Current reports indicate that the presence of a lead in the right ventricle (RV) and chronic cardiac pacing may be associated with adverse clinical outcomes during a long-term follow-up.
AIMS: The aim of the study was to evaluate outcomes of cardiac implantable electronic device (CIED) placement on the development of pacing-induced cardiomyopathy (PICM) as well as other unfavorable changes in cardiac structure and function.
MATERIAL AND METHODS: In a single-center study we included patients after first-time implantation of a CIED without cardiac resynchronization therapy capability, with available electronic documentation of transthoracic echocardiography results up to 1 year before and at least 1 month after CIED placement. A detailed medical documentation review was performed.
RESULTS: Among 94 patients with mean age 70 (range 65-79) years, including 29 (30.9%) women, after a median 12-month follow-up, PICM was observed in 11% of patients (all with atrial fibrillation and RV pacing percentage ≥20%), while mitral and tricuspid regurgitation progressed in 31.9% and 25.5% of patients, respectively. Older age and lower left ventricular ejection fraction (LVEF) before CIED implantation (hazard ratio [HR], 1.14; 95% confidence interval [CI], 1.02-1.29; P = 0.03 and HR, 0.93; 95% CI, 0.87-0.99; P = 0.02, respectively) were independently associated with development of PICM. There was no association of RV lead pacing site (RV outflow tract, septum, and apex) with this outcome.
CONCLUSIONS: Patients with atrial fibrillation, older age, expected substantial RV pacing, and decreased LVEF before CIED implantation should be considered for other approaches of pacing, rather than utilizing non-apical right ventricular lead placement to prevent PICM.
AIMS: The aim of the study was to evaluate outcomes of cardiac implantable electronic device (CIED) placement on the development of pacing-induced cardiomyopathy (PICM) as well as other unfavorable changes in cardiac structure and function.
MATERIAL AND METHODS: In a single-center study we included patients after first-time implantation of a CIED without cardiac resynchronization therapy capability, with available electronic documentation of transthoracic echocardiography results up to 1 year before and at least 1 month after CIED placement. A detailed medical documentation review was performed.
RESULTS: Among 94 patients with mean age 70 (range 65-79) years, including 29 (30.9%) women, after a median 12-month follow-up, PICM was observed in 11% of patients (all with atrial fibrillation and RV pacing percentage ≥20%), while mitral and tricuspid regurgitation progressed in 31.9% and 25.5% of patients, respectively. Older age and lower left ventricular ejection fraction (LVEF) before CIED implantation (hazard ratio [HR], 1.14; 95% confidence interval [CI], 1.02-1.29; P = 0.03 and HR, 0.93; 95% CI, 0.87-0.99; P = 0.02, respectively) were independently associated with development of PICM. There was no association of RV lead pacing site (RV outflow tract, septum, and apex) with this outcome.
CONCLUSIONS: Patients with atrial fibrillation, older age, expected substantial RV pacing, and decreased LVEF before CIED implantation should be considered for other approaches of pacing, rather than utilizing non-apical right ventricular lead placement to prevent PICM.