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Tsurumi N, Naruse Y, Kurebayashi N, Morikawa S, Sano M, Shiozawa T, Takano S, Ogano M, Kimura K, Miyajima K, Sugiura R, Henmi R, Muto M, Hosoya N, Hasebe H, Mizukami A, Iguchi K, Atsumi A, Odagiri K, Yanagisawa S, Inden Y, Murohara T, Maekawa Y. Mid-term outcomes of delivery catheter-based and stylet-based right ventricular septal pacing: Follow-up results from a multicenter, prospective, randomized study. J Arrhythm 2024; 40:605-613. [PMID: 38939791 PMCID: PMC11199805 DOI: 10.1002/joa3.13034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Revised: 03/10/2024] [Accepted: 03/25/2024] [Indexed: 06/29/2024] Open
Abstract
Background The Mt FUJI study was a multicenter, prospective, randomized, single-blind, controlled trial comparing delivery catheter-based and stylet-based right ventricular (RV) lead placement at the RV septum. This study extended the follow-up duration to 1 year after implantation. Methods Seventy patients with pacemaker indications for atrioventricular block were randomly assigned to the delivery catheter and stylet groups. We compared the mid-term efficacy and safety between the two groups at 1 year after implantation. The primary outcome was the change in the left ventricular ejection fraction (LVEF), and the secondary outcomes were changes in brain natriuretic peptide (BNP) levels, lead parameters, paced QRS duration, and the incidence of adverse events. Results At the 1-year follow-up, no significant differences were observed in the changes in the LVEF (+1.0% ± 8.6% vs. +3.1% ± 8.1%, p = .332), BNP levels (+8.0 [-11.1, 26.5] pg/mL vs. -8.7 [-15.3, 13.2] pg/mL, p = .193), or lead performance between the delivery catheter and stylet groups. The QRS duration was significantly shorter in the delivery catheter group than in the stylet group (128 ± 23 ms vs. 146 ± 17 ms, p < .001). All-cause death, hospitalization for heart failure, new development of atrial fibrillation, and pacing-induced cardiomyopathy occurred in seven patients in the delivery catheter group and five in the stylet group. Conclusion The delivery catheter system was similarly useful and safe compared to the stylet system in the mid-term follow-up from the Mt FUJI trial. Further long-term evaluations are warranted.
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Affiliation(s)
- Naoki Tsurumi
- Department of CardiologyChutoen General Medical CenterKakegawaShizuokaJapan
- Department of CardiologyNagoya University Graduate School of MedicineNagoyaAichiJapan
| | - Yoshihisa Naruse
- Division of Cardiology, Internal Medicine IIIHamamatsu University School of MedicineHamamatsuShizuokaJapan
| | | | - Shuji Morikawa
- Department of CardiologyChutoen General Medical CenterKakegawaShizuokaJapan
- Department of CardiologyNagoya University Graduate School of MedicineNagoyaAichiJapan
| | - Makoto Sano
- Division of Cardiology, Internal Medicine IIIHamamatsu University School of MedicineHamamatsuShizuokaJapan
| | - Tomoyuki Shiozawa
- Department of CardiologyJuntendo University Shizuoka HospitalIzunokuniShizuokaJapan
| | - Shintaro Takano
- Department of CardiologyJuntendo University Shizuoka HospitalIzunokuniShizuokaJapan
| | - Michio Ogano
- Department of Cardiovascular MedicineShizuoka Medical CenterSunto‐gunShizuokaJapan
| | - Kei Kimura
- Department of Cardiovascular MedicineShizuoka Medical CenterSunto‐gunShizuokaJapan
| | - Keisuke Miyajima
- Department of CardiologySeirei Mikatahara General HospitalHamamatsuShizuokaJapan
| | - Ryo Sugiura
- Department of CardiologySeirei Hamamatsu General HospitalHamamatsuShizuokaJapan
| | - Ryuta Henmi
- Department of CardiologySeirei Hamamatsu General HospitalHamamatsuShizuokaJapan
| | - Masahiro Muto
- Department of CardiologyHamamatsu Medical CenterHamamatsuShizuokaJapan
| | - Natsuko Hosoya
- Department of CardiologyHamamatsu Medical CenterHamamatsuShizuokaJapan
| | - Hideyuki Hasebe
- Division of ArrhythmologyShizuoka Saiseikai General HospitalShizuokaJapan
| | - Akira Mizukami
- Department of CardiologyKameda Medical CenterKamogawaJapan
| | - Keisuke Iguchi
- Division of Cardiology, Internal Medicine IIIHamamatsu University School of MedicineHamamatsuShizuokaJapan
| | - Akiko Atsumi
- Department of CardiologyShintoshi HospitalIwataJapan
| | - Keiichi Odagiri
- Center for Clinical ResearchHamamatsu University HospitalHamamatsuShizuokaJapan
| | - Satoshi Yanagisawa
- Department of CardiologyNagoya University Graduate School of MedicineNagoyaAichiJapan
| | - Yasuya Inden
- Department of CardiologyNagoya University Graduate School of MedicineNagoyaAichiJapan
| | - Toyoaki Murohara
- Department of CardiologyNagoya University Graduate School of MedicineNagoyaAichiJapan
| | - Yuichiro Maekawa
- Division of Cardiology, Internal Medicine IIIHamamatsu University School of MedicineHamamatsuShizuokaJapan
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Gul EE, Ghazni MS, Gamal G. Pacemaker-induced Cardiomyopathy in Patients with Coronary Artery Disease: A Report of Three Cases. J Innov Card Rhythm Manag 2024; 15:5735-5738. [PMID: 38304093 PMCID: PMC10829413 DOI: 10.19102/icrm.2024.15011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 07/31/2023] [Indexed: 02/03/2024] Open
Abstract
Pacing-induced cardiomyopathy (PICM) is defined as a drop in left ventricular ejection fraction (LVEF) in the setting of chronic, high-burden right ventricular pacing. Cardiac resynchronization therapy (CRT) and conduction system pacing (CSP) have been proposed to manage PICM. Although acute myocardial infarction has been described as a predictor of PICM, there are no guideline recommendations for CRT or CSP in patients with coronary artery disease (CAD) and preserved LVEF. In this report, we present and discuss three cases of PICM in patients with CAD and preserved LVEF.
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Affiliation(s)
- Enes Elvin Gul
- Division of Cardiac Electrophysiology, Madinah Cardiac Centre, Madinah, Saudi Arabia
| | | | - Gehad Gamal
- Division of Cardiac Electrophysiology, Madinah Cardiac Centre, Madinah, Saudi Arabia
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Rorsman C, Farouq M, Marinko S, Mörtsell D, Chaudhry U, Wang L, Borgquist R. Sex-based differences in cardiac resynchronization therapy upgrade and outcome for patients with pacemaker and new-onset heart failure. Pacing Clin Electrophysiol 2023; 46:1153-1161. [PMID: 37638818 DOI: 10.1111/pace.14796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 06/29/2023] [Accepted: 07/17/2023] [Indexed: 08/29/2023]
Abstract
BACKGROUND Patients with chronic right ventricular (RV) pacing are at an increased risk of heart failure. Previous studies have indicated that cardiac resynchronization therapy (CRT) is underused in this setting, and that there may be sex-based differences in both CRT use and clinical outcome. OBJECTIVE To evaluate sex-based differences in CRT use and clinical outcome for patients with new-onset heart failure post RV pacing. METHODS Data from the Swedish pacemaker registry was matched with data from the national death and disease registries. Patients with de novo pacemaker implant due to AV block during the period 2005-2020 were included. New-onset heart-failure within two years post-implant was evaluated, primary outcome was all-cause mortality. RESULTS In all, 30183 patients (37% female) were included. Women were on average 3 years older, but had less comorbidities than men. Median follow-up time was 4.5 [2.0-8.0] years. Women had better age- and comorbidity-adjusted survival (HR 0.78 [0.73-0.84], p < .001). For the 3560 patients (12.4% men and 10.7% women, p < .001) who were diagnosed with new-onset heart failure, 5-year mortality was similar for men and women (50% vs. 48%, p = .29). However, women were less likely to receive CRT-upgrade (3.8% vs. 9.1%, p < .001), and those who did were almost ten years younger than the men. CONCLUSION Women with pacemaker due to AV block are older but have less comorbidities than men. They are less likely to develop new-onset heart failure, but also less likely to receive a CRT upgrade if they do develop heart failure. Increased awareness of the positive effects of CRT upgrade and potential sex- and age-based discrimination is warranted.
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Affiliation(s)
- Cecilia Rorsman
- Cardiology, Department of Clinical, Sciences, Lund University, Lund, Sweden
- Internal Medicine Department, Varberg Hospital, Varberg, Sweden
| | - Maiwand Farouq
- Cardiology, Department of Clinical, Sciences, Lund University, Lund, Sweden
- Arrhythmia Section, Skane University Hospital, Lund, Sweden
| | - Sofia Marinko
- Cardiology, Department of Clinical, Sciences, Lund University, Lund, Sweden
- Arrhythmia Section, Skane University Hospital, Lund, Sweden
| | - David Mörtsell
- Cardiology, Department of Clinical, Sciences, Lund University, Lund, Sweden
- Arrhythmia Section, Skane University Hospital, Lund, Sweden
| | - Uzma Chaudhry
- Cardiology, Department of Clinical, Sciences, Lund University, Lund, Sweden
- Arrhythmia Section, Skane University Hospital, Lund, Sweden
| | - Lingwei Wang
- Cardiology, Department of Clinical, Sciences, Lund University, Lund, Sweden
- Arrhythmia Section, Skane University Hospital, Lund, Sweden
| | - Rasmus Borgquist
- Cardiology, Department of Clinical, Sciences, Lund University, Lund, Sweden
- Arrhythmia Section, Skane University Hospital, Lund, Sweden
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Christoph M, Marius S, Karl S, Friedrich K. Efficacy of CRT upgrade in pacemaker-induced cardiomyopathy in an outpatient clinic - Results of a prospective registry. Int J Cardiol 2023; 377:60-65. [PMID: 36738844 DOI: 10.1016/j.ijcard.2023.01.077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 01/18/2023] [Accepted: 01/26/2023] [Indexed: 02/05/2023]
Abstract
PURPOSE The aim of this prospective, monocentric registry study was to investigate whether upgrading to cardiac resynchronization therapy (CRT) in pacemaker-induced cardiomyopathy (PICM) can improve left ventricular function in typical outpatient clinical patients. METHODS We screened for PICM in a pacemaker outpatient clinic between 2017 and 2021. The follow-up period was 6 months. The primary endpoint was decreased left ventricular end systolic volume (LVESV), and the responder criterion was decreased LVESV >15%. Secondary endpoints were LVEF, NYHA class, device-associated complications and death. RESULTS 66 patients were newly diagnosed with PICM. 55 of them received a CRT upgrade. For the primary endpoint, LVESV decreased from 101.6 ± 48.2 ml to 75.9 ± 35.8 ml (p < 0.001). Secondary endpoints were: a) LVEF increased from 31.5 ± 5.4% to 46.1 ± 7.6% (p < 0.001) and b) NYHA class improved by an average of one class in both groups (p < 0.001). The overall complication rate was 1.8%. CONCLUSIONS CRT upgrade in outpatient clinic patients with PICM improves left ventricular function and functional capacity and is associated with an acceptable complication rate.
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Affiliation(s)
- Melzer Christoph
- Herzschrittmacher- und ICD-Zentrum, Berlin, 10439 Berlin, Germany.
| | - Schwerg Marius
- Department of Cardiology, Martin-Luther-Krankenhaus, 14193 Berlin, Germany
| | - Stangl Karl
- Department of Cardiology and Angiology, Campus Mitte, Charité Universitätsmedizin Berlin, 10117 Berlin, Germany
| | - Köhler Friedrich
- Department of Cardiology and Angiology, Campus Mitte, Charité Universitätsmedizin Berlin, 10117 Berlin, Germany
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Kaza N, Htun V, Miyazawa A, Simader F, Porter B, Howard JP, Arnold AD, Naraen A, Luria D, Glikson M, Israel C, Francis DP, Whinnett ZI, Shun-Shin MJ, Keene D. Upgrading right ventricular pacemakers to biventricular pacing or conduction system pacing: a systematic review and meta-analysis. Europace 2023; 25:1077-1086. [PMID: 36352513 PMCID: PMC10062368 DOI: 10.1093/europace/euac188] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 09/08/2022] [Indexed: 11/11/2022] Open
Abstract
Guidelines recommend patients undergoing a first pacemaker implant who have even mild left ventricular (LV) impairment should receive biventricular or conduction system pacing (CSP). There is no corresponding recommendation for patients who already have a pacemaker. We conducted a meta-analysis of randomized controlled trials (RCTs) and observational studies assessing device upgrades. The primary outcome was the echocardiographic change in LV ejection fraction (LVEF). Six RCTs (randomizing 161 patients) and 47 observational studies (2644 patients) assessing the efficacy of upgrade to biventricular pacing were eligible for analysis. Eight observational studies recruiting 217 patients of CSP upgrade were also eligible. Fourteen additional studies contributed data on complications (25 412 patients). Randomized controlled trials of biventricular pacing upgrade showed LVEF improvement of +8.4% from 35.5% and observational studies: +8.4% from 25.7%. Observational studies of left bundle branch area pacing upgrade showed +11.1% improvement from 39.0% and observational studies of His bundle pacing upgrade showed +12.7% improvement from 36.0%. New York Heart Association class decreased by -0.4, -0.8, -1.0, and -1.2, respectively. Randomized controlled trials of biventricular upgrade found improvement in Minnesota Heart Failure Score (-6.9 points) and peak oxygen uptake (+1.1 mL/kg/min). This was also seen in observational studies of biventricular upgrades (-19.67 points and +2.63 mL/kg/min, respectively). In studies of the biventricular upgrade, complication rates averaged 2% for pneumothorax, 1.4% for tamponade, and 3.7% for infection over 24 months of mean follow-up. Lead-related complications occurred in 3.3% of biventricular upgrades and 1.8% of CSP upgrades. Randomized controlled trials show significant physiological and symptomatic benefits of upgrading pacemakers to biventricular pacing. Observational studies show similar effects between biventricular pacing upgrade and CSP upgrade.
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Affiliation(s)
- Nandita Kaza
- National Heart and Lung Institute, Imperial College London, B Block, Hammersmith Hospital, Du Cane Road, London W12 0HS, UK
| | - Varanand Htun
- School of Public Health, Imperial College London, London, UK
| | - Alejandra Miyazawa
- National Heart and Lung Institute, Imperial College London, B Block, Hammersmith Hospital, Du Cane Road, London W12 0HS, UK
| | - Florentina Simader
- National Heart and Lung Institute, Imperial College London, B Block, Hammersmith Hospital, Du Cane Road, London W12 0HS, UK
| | - Bradley Porter
- Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - James P Howard
- Warrington and Halton Hospitals NHS Foundation Trust, Liverpool, UK
| | - Ahran D Arnold
- National Heart and Lung Institute, Imperial College London, B Block, Hammersmith Hospital, Du Cane Road, London W12 0HS, UK
| | - Akriti Naraen
- Warrington and Halton Hospitals NHS Foundation Trust, Liverpool, UK
| | - David Luria
- Hebrew University Jerusalem, Jerusalem, Israel
| | | | | | - Darrel P Francis
- National Heart and Lung Institute, Imperial College London, B Block, Hammersmith Hospital, Du Cane Road, London W12 0HS, UK
| | - Zachary I Whinnett
- National Heart and Lung Institute, Imperial College London, B Block, Hammersmith Hospital, Du Cane Road, London W12 0HS, UK
| | - Matthew J Shun-Shin
- National Heart and Lung Institute, Imperial College London, B Block, Hammersmith Hospital, Du Cane Road, London W12 0HS, UK
| | - Daniel Keene
- National Heart and Lung Institute, Imperial College London, B Block, Hammersmith Hospital, Du Cane Road, London W12 0HS, UK
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Adverse effects of right ventricular pacing on cardiac function: prevalence, prevention and treatment with physiologic pacing. Trends Cardiovasc Med 2023; 33:109-122. [PMID: 34742888 DOI: 10.1016/j.tcm.2021.10.013] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 10/24/2021] [Accepted: 10/30/2021] [Indexed: 02/07/2023]
Abstract
Right ventricular (RV) pacing is the main treatment modality for patients with advanced atrioventricular (AV) block. Chronic RV pacing can cause cardiac systolic dysfunction and heart failure (HF). In this review, we discuss studies that have shown deleterious effects of chronic RV pacing on systolic cardiac function causing pacing-induced cardiomyopathy (PiCM), heart failure (HF), HF hospitalization, atrial fibrillation (AF) and cardiac mortality. RV apical pacing is the most widely used and studied. Adverse effects of RV pacing appear to be directly related to pacing burden and are worse in patients with pre-existing left ventricular (LV) dysfunction. Chronic RV pacing is also associated with heart failure with preserved ejection fraction (HFpEF). Mechanisms, risk factors, clinical and echocardiographic features, and strategies to minimize RV pacing-induced cardiac dysfunction are discussed in light of the latest data. Studies on biventricular (Bi-V) pacing upgrade in patients who develop RV PiCM, use of alternate RV pacing sites, de novo Bi-V pacing, and physiologic pacing using HIS bundle pacing (HBP) and left bundle area (LBBA) pacing in patients with an anticipated high RV pacing burden are discussed.
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7
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Somma V, Ha FJ, Palmer S, Mohamed U, Agarwal S. Pacing-induced cardiomyopathy: A systematic review and meta-analysis of definition, prevalence, risk factors, and management. Heart Rhythm 2023; 20:282-290. [PMID: 36356656 DOI: 10.1016/j.hrthm.2022.09.019] [Citation(s) in RCA: 21] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Revised: 09/20/2022] [Accepted: 09/23/2022] [Indexed: 11/09/2022]
Abstract
Pacing-induced cardiomyopathy is a potential complication of right ventricular pacing. Definition varies between studies and the optimal management approach is uncertain. We aimed to characterize definition, prevalence, risk factors, and treatment strategies of pacing-induced cardiomyopathy (PiCM). We performed a systematic review and meta-analysis of studies that evaluated PiCM after pacemaker implantation identified through a literature search of PubMed and EMBASE up to March 2022. We collected data on the study definition of PiCM and calculated pooled prevalence across studies. Meta-analysis with random effects modeling was used to assess the association between potential risk factors and PiCM, reported as odds ratio with 95% confidence interval. Twenty-six studies (6 prospective studies) with a total of 57,993 patients (mean/median age range was 51-78 years; female 45%) were included in the final analysis. Fifteen unique definitions of PiCM were reported. The pooled prevalence of PiCM was 12% (95% confidence interval 11%-14%). In meta-analysis, risk factors included male sex, history of myocardial infarction, chronic kidney disease, atrial fibrillation, baseline left ventricular ejection fraction, native QRS duration, right ventricular pacing percentage, and paced QRS duration. Treatment strategies identified included biventricular cardiac resynchronization therapy (6 studies) and His-bundle pacing (3 studies). Definition of PiCM varied significantly between studies. More than 1 in 10 patients with chronic right ventricular pacing developed PiCM. Key risk factors included baseline left ventricular ejection fraction, native QRS duration, RV pacing percentage, and paced QRS duration. The optimal management strategy has yet to be defined. Further research is needed to define and treat this understated complication.
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Affiliation(s)
- Vincenzo Somma
- Department of Cardiology, St Vincent's Hospital Melbourne, Melbourne, Australia
| | - Francis J Ha
- Department of Cardiology, St Vincent's Hospital Melbourne, Melbourne, Australia.
| | - Sonny Palmer
- Department of Cardiology, St Vincent's Hospital Melbourne, Melbourne, Australia
| | - Uwais Mohamed
- Department of Cardiology, St Vincent's Hospital Melbourne, Melbourne, Australia
| | - Sharad Agarwal
- Royal Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom
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The Therapeutic Benefit of Upgrade to Cardiac Resynchronization Therapy in Patients with Pacing Induced Cardiomyopathy. Heart Rhythm O2 2023; 4:225-231. [PMID: 37124556 PMCID: PMC10134389 DOI: 10.1016/j.hroo.2023.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Background Pacing-induced cardiomyopathy (PICM) is an important cause of heart failure in patients with a right ventricular pacing burden. Recent evidence suggests that an upgrade to cardiac resynchronization therapy (CRT) may confer benefit in PICM. Objective To assess the extent and identify predictors of improvement following upgrade to CRT in patients with PICM. Methods We retrospectively analyzed 43 patients undergoing CRT upgrade for PICM over the 10-year period of 2011 to 2021 at our center. All patients with PICM who underwent device upgrade from a dual- or single-chamber ventricular pacemaker to CRT were included. PICM was defined as a decrease of ≥10% in left ventricular ejection fraction (LVEF), resulting in an LVEF <50% among patients with ≥20% Right ventricular pacing burden without an alternative cause for cardiomyopathy. Results LVEF significantly improved from 28.7% preupgrade to 44.3% post-CRT upgrade (P < .01). Of 37 patients with severe LV dysfunction, 34 (91.9%) improved to an LVEF >35% and 13 (35.1%) improved to an LVEF >50%. The LV end-diastolic diameter decreased from 5.9 cm preupgrade to 5.4 cm postupgrade (P < .01). Using linear regression, angiotensin-converting enzyme inhibitor or angiotensin receptor blocker use was associated with significant LVEF improvement (+7.21%, P = .05). We observed a low rate of complications, and 1 in 4 CRT upgrades required venoplasty (n = 10 of 43, 23.3%). Conclusion We provide further evidence for the benefit of CRT upgrade in the management of patients with PICM.
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Abstract
PURPOSE OF THE REVIEW Dyssynchrony occurs when portions of the cardiac chambers contract in an uncoordinated fashion. Ventricular dyssynchrony primarily impacts the left ventricle and may result in heart failure. This entity is recognized as a major contributor to the development and progression of heart failure. A hallmark of dyssynchronous heart failure (HFd) is left ventricular recovery after dyssynchrony is corrected. This review discusses the current understanding of pathophysiology of HFd and provides clinical examples and current techniques for treatment. RECENT FINDINGS Data show that HFd responds poorly to medical therapy. Cardiac resynchronization therapy (CRT) in the form of conventional biventricular pacing (BVP) is of proven benefit in HFd, but is limited by a significant non-responder rate. Recently, conduction system pacing (His bundle or left bundle branch area pacing) has also shown promise in correcting HFd. HFd should be recognized as a distinct etiology of heart failure; HFd responds best to CRT.
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Affiliation(s)
- Sean J Dikdan
- Thomas Jefferson University Hospital, Philadelphia, PA, 19107, USA
| | | | - Behzad B Pavri
- Thomas Jefferson University Hospital, Philadelphia, PA, 19107, USA.
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10
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Incidence and predictors of pacemaker-induced cardiomyopathy with right ventricular pacing: a systematic review. Expert Rev Cardiovasc Ther 2022; 20:267-273. [PMID: 35365062 DOI: 10.1080/14779072.2022.2062323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
INTRODUCTION This systematic review aims to evaluate the incidence and predictors of PICM in patients undergoing right ventricular pacing. AREAS COVERED A literature review was conducted using Mesh terms (Right ventricular pacing, Pacemaker-related cardiomyopathy, Pacemaker-induced cardiomyopathy) in PubMed, EMBASE, Web of science CINAHL, and the Cochrane Library until October 2021. All data reporting the incidence of PICM after implantation of right-sided pacemakers or implantable cardioverter-defibrillator (ICD) were retrieved from the eligible studies. EXPERT OPINION Out of 3,625 articles, 20 studies met the inclusion criteria that included 5,381 patients with PICM. The mean age of the patients ranged between 55.8 ± 13.5 and 77.4 ± 10.8 years. The mean incidence of PICM was 25.7%. Mean EF at baseline ranged from 48 ± 1% and 62.1 ± 11.2%, while mean EF at follow up ranged between 33.7± 7.4% and 53.2 ± 8.2%. Three studies reported a decline of >20% EF at follow-up. RV pacing was associated with a considerable risk of PICM, with biological factors such as male gender, old age, increased QRS duration, and chronic RV pacing burden playing an important role in the development of disease.
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Lu W, Lin J, Dai Y, Chen K, Zhang S. The therapeutic effects of upgrade to cardiac resynchronization therapy in pacing-induced cardiomyopathy or chronic right ventricular pacing patients: a meta-analysis. Heart Fail Rev 2021; 27:507-516. [PMID: 33638772 DOI: 10.1007/s10741-021-10091-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/18/2021] [Indexed: 11/30/2022]
Abstract
Pacing-induced cardiomyopathy (PICM) or heart failure accompanied with chronic right ventricular pacing (CRVP-HF) has no established treatments. We aimed to carry out a meta-analysis of published studies about the therapeutic effects of the upgrade to cardiac resynchronization therapy (CRT) in patients of PICM/CRVP-HF. The PUBMED, EMBASE, MEDLINE, OVID databases, and Cochrane Library were systemically searched for relevant publications. Data about the improvements of left ventricular ejection fraction (LVEF), NYHA functional class (NYHA-FC), and the CRT response rate was extracted and synthesized. Mean difference (MD), odds ratio, and standard mean difference (SMD) with 95% confidence interval (CI) were calculated as the effect size by both fixed and random effect models. We included sixteen studies (four about PICM and twelve about CRVP-HF). The total sample size of PICM/CRVP-HF patients was 924. Upgrade to CRT improved the LVEF by 10.87% (95%CI, 8.90 to 12.84%) and reduce the NYHA-FC by around one class (MD, -1.25; 95%CI, -1.43 to -1.06) in PICM/CRVP-HF patients overall. Upgrade to CRT seemed to improve LVEF no less than de-novo CRT (SMD 0.24; 95%CI 0.05 to 0.43; P < 0.05). This meta-analysis suggested that upgrade CRT could improve the cardiac function in PICM/CRVP-HF patients. This strategy may be considered in these patients but require more evidence about the efficacy and procedure-related complications from prospective studies or randomized controlled trials.
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Affiliation(s)
- Wenzhao Lu
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, No. 167, Beilishi Road, Xicheng District, Beijing, 100037, China
| | - Jinxuan Lin
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, No. 167, Beilishi Road, Xicheng District, Beijing, 100037, China
| | - Yan Dai
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, No. 167, Beilishi Road, Xicheng District, Beijing, 100037, China
| | - Keping Chen
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, No. 167, Beilishi Road, Xicheng District, Beijing, 100037, China.
| | - Shu Zhang
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, No. 167, Beilishi Road, Xicheng District, Beijing, 100037, China
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Dor O, Haim M, Barrett O, Novack V, Konstantino Y. Incidence and Clinical Outcomes of Pacing Induced Cardiomyopathy in Patients With Normal Left Ventricular Systolic Function and Atrioventricular Block. Am J Cardiol 2020; 128:174-180. [PMID: 32650916 DOI: 10.1016/j.amjcard.2020.05.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 05/09/2020] [Accepted: 05/12/2020] [Indexed: 10/24/2022]
Abstract
Patients with preserved left ventricular (LV) ejection function (EF) and atrioventricular block (AVB) who are anticipated for high-burden of right ventricular (RV) pacing possess a risk to develop pacing-induced cardiomyopathy (PIC) and adverse clinical outcomes. Hence, the aim of the study is to evaluate the incidence, predictors, and clinical outcomes of RV PIC in patients with preserved LVEF, AVB, and high-burden of RV pacing. One thousand and thirteen patients with second or third-degree AVB underwent first time pacemaker implantation between January 2002 and August 2016. A total of 203 patients with a newly implanted pacemaker, normal baseline LVEF, and high burden of RV pacing were included in the present study. Follow-up echocardiography was examined for a new decrease in LVEF of 10% or higher. Alternative causes for cardiomyopathy were ruled out. Patient characteristics, echocardiographic measurements, device clinic data, mortality, and hospitalizations for heart failure were collected and compared between the PIC and the non-PIC groups. Fifty-one patients (25%) developed LV dysfunction with 22 patients (11%), showing LVEF < 40%. During a mean follow-up of 49.2 months, the risk of heart failure hospitalization or all-cause mortality was significantly higher in the PIC group versus non-PIC group (35.3% vs 19.1%, p = 0.009). In conclusion the incidence of PIC in patients with normal LVEF and AVB, who are anticipated for high-burden of RV pacing is high. PIC in patients with a previously normal LV function is associated with unfavorable long-term clinical outcomes, including higher rates of heart failure hospitalizations and all-cause mortality.
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Prevalence of left ventricular systolic dysfunction in a typical outpatient pacemaker cohort. Herzschrittmacherther Elektrophysiol 2020; 31:219-223. [PMID: 32377903 PMCID: PMC7272385 DOI: 10.1007/s00399-020-00683-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 04/12/2020] [Indexed: 12/02/2022]
Abstract
Background Right ventricular (RV) pacing is the standard treatment for symptomatic bradycardia. RV pacing is known to cause dyssyncrony. New treatment options like His bundle pacing enhance the focus on left ventricular dysfunction in patients with pacemakers. Objectives The aim of this cross-sectional study was to obtain a real-life picture of the patients in a representative cohort of outpatients with permanent pacemakers. The prevalence and causes of left ventricular dysfunction (LVD) were explored. Methods In total, 1869 patients of a pacemaker outpatient clinic were screened for left ventricular systolic dysfunction by transthoracic echocardiography. All patients were interviewed for symptoms and cardiologist care. Percentages of RV pacing and underlying cardiac disease were recorded. Results A left ventricular ejection fraction (LVEF) under 45% was found in 207 (11.1%) of all patients. Predictive factors for a reduced LVEF were a high pacing rate and long-term pacing. LVD due to RV pacing was diagnosed in 3.4% of all patients. Only 845 patients (45%) reported that they regularly visited a cardiologist. Conclusion There is a high prevalence of unknown LVD in a typical pacemaker cohort. Therefore, regular echocardiographic examinations should be performed in outpatients of pacemaker clinics.
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Cho SW, Gwag HB, Hwang JK, Chun KJ, Park KM, On YK, Kim JS, Park SJ. Clinical features, predictors, and long-term prognosis of pacing-induced cardiomyopathy. Eur J Heart Fail 2019; 21:643-651. [PMID: 30734436 DOI: 10.1002/ejhf.1427] [Citation(s) in RCA: 69] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 11/28/2018] [Accepted: 01/04/2019] [Indexed: 12/28/2022] Open
Abstract
AIMS We investigated the clinical features, predictors, and long-term prognosis of pacing-induced cardiomyopathy (PiCM). METHODS AND RESULTS From a retrospective analysis of 1418 consecutive pacemaker patients, 618 were found to have a preserved baseline left ventricular ejection fraction (LVEF), follow-up echocardiographic data, and no history of heart failure (HF). PiCM was defined as a reduction in LVEF (< 50%) along with either (i) a ≥ 10% decrease in LVEF, or (ii) new-onset regional wall motion abnormality unrelated to coronary artery disease. PiCM occurred in 87 of 618 patients (14.1%), with a decrease in mean LVEF from 60.5% to 40.1%. The median time to PiCM was 4.7 years. Baseline left bundle branch block, wider paced QRS duration (≥ 155 ms), and higher ventricular pacing percentage (≥ 86%) were identified as independent predictors of PiCM in multivariate logistic regression analysis. The risk of PiCM increased gradually with the number of identified predictors, becoming more significant in the presence of two or more predictors (P < 0.001). During the entire follow-up (median 7.2 years), the risk of all-cause death or HF admission was significantly higher in patients with PiCM compared to those without PiCM (38.3% vs. 54.0%, adjusted hazard ratio 2.93; 95% confidence interval 1.82-4.72; P < 0.001). CONCLUSION Pacing-induced cardiomyopathy patients showed a worse long-term prognosis than those without PiCM. Therefore, patients with multiple risk factors of PiCM should be monitored carefully even if their left ventricular systolic function is preserved initially. A timely upgrade to a biventricular or His-bundle pacing device needs to be considered in patients with PiCM.
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Affiliation(s)
- Sung Woo Cho
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Inje University, Seoul Paik Hospital, Seoul, Korea
| | - Hye Bin Gwag
- Division of Cardiology, Department of Internal Medicine, Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jin Kyung Hwang
- Division of Cardiology, Department of Medicine, Veterans Health Service Medical Center, Seoul, Korea
| | - Kwang Jin Chun
- Division of Cardiology, Department of Internal Medicine, Kangwon National University College of Medicine Hospital, Chuncheon, Korea
| | - Kyoung-Min Park
- Division of Cardiology, Department of Internal Medicine, Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young Keun On
- Division of Cardiology, Department of Internal Medicine, Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - June Soo Kim
- Division of Cardiology, Department of Internal Medicine, Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seung-Jung Park
- Division of Cardiology, Department of Internal Medicine, Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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KNILANS TIMOTHYK, CZOSEK RICHARDJ. Rounding Up the Usual Suspects: Nonsustained Ventricular Tachycardia and Sustained Left Ventricular Dysfunction as Risk Factors for Sudden Death in Isolated AV Block. J Cardiovasc Electrophysiol 2016; 27:480-1. [DOI: 10.1111/jce.12943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Accepted: 01/25/2016] [Indexed: 11/28/2022]
Affiliation(s)
- TIMOTHY K. KNILANS
- Cincinnati Children's Hospital Medical Center; University of Cincinnati College of Medicine; Cincinnati Ohio USA
| | - RICHARD J. CZOSEK
- Cincinnati Children's Hospital Medical Center; University of Cincinnati College of Medicine; Cincinnati Ohio USA
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