Cardiac pacemakers and implantable cardioverter-defibrillators without cardiac resynchronization capability: Impact on cardiac function in a median follow-up of 1-year.

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.