1
|
Schupp T, Schmitt A, Lau F, Reinhardt M, Abel N, Abumayyaleh M, Ayoub M, Mashayekhi K, Akin M, Rusnak J, Weidner K, Akin I, Behnes M. Distribution and Prognostic Impact of Different Heart Failure Etiologies in Patients with Heart Failure with Mildly Reduced Ejection Fraction. Eur J Intern Med 2024:S0953-6205(24)00292-9. [PMID: 39030147 DOI: 10.1016/j.ejim.2024.07.009] [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: 01/14/2024] [Revised: 05/28/2024] [Accepted: 07/05/2024] [Indexed: 07/21/2024]
Abstract
OBJECTIVE The study investigates the characteristics and prognostic impact of different heart failure (HF) etiologies in patients with heart failure with mildly reduced ejection fraction (HFmrEF). BACKGROUND Data regarding the characterization of patients with HFmrEF and their outcomes is scarce. METHODS Consecutive patients with HFmrEF (i.e., left ventricular ejection fraction 41-49 % and signs and/or symptoms of HF) were retrospectively included at one institution from 2016 to 2022. Patients with ischemic cardiomyopathy (ICM) were compared to patients without ischemic cardiomyopathy (non-ICM). The primary endpoint was all-cause mortality at 30 months (median follow-up). Statistical analyses included Kaplan-Meier, multivariable Cox proportional regression analyses and propensity score matching. RESULTS From a total of 1,832 patients hospitalized with HFmrEF, ICM was the most common HF etiology in 68.7 %, followed by hypertensive (9.7 %) and primary non-ischemic cardiomyopathies (NICM) (8.1 %). Within the entire study cohort, the presence of ICM was not associated with the risk of all-cause mortality (HR = 0.864; 95 % CI 0.723 - 1.031), however after multivariable adjustment (HR = 0.792; 95 % CI 0.646 - 0.972; p = 0.026) and propensity score matching (25.7% vs. 31.4 %; log rank p = 0.050), the presence of ICM was associated with lower risk of all-cause mortality at 30 months compared to patients without ICM. CONCLUSION ICM is the most common etiology of HF in HFmrEF and may be associated with favorable outcomes. This may be related to better adherence to pharmacological treatment and improved revascularization strategies for HFmrEF patients with ICM.
Collapse
Affiliation(s)
- Tobias Schupp
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Germany.
| | - Alexander Schmitt
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Germany
| | - Felix Lau
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Germany
| | - Marielen Reinhardt
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Germany
| | - Noah Abel
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Germany
| | - Mohammad Abumayyaleh
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Germany
| | - Mohamed Ayoub
- Division of Cardiology and Angiology, Heart Center University of Bochum - Bad Oeynhausen, Germany
| | - Kambis Mashayekhi
- Department of Internal Medicine and Cardiology, Mediclin Heart Centre Lahr, Lahr, Germany
| | - Muharrem Akin
- Department of Cardiology, Angiology, Hannover Medical School, Carl-Neuberg Straße 1, 30625 Hannover, Germany
| | - Jonas Rusnak
- Department of Cardiology, Angiology and Pneumology, University Hospital Heidelberg, 69120 Heidelberg, Germany
| | - Kathrin Weidner
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Germany
| | - Ibrahim Akin
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Germany
| | - Michael Behnes
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Germany
| |
Collapse
|
2
|
Malikides O, Simantirakis E, Zacharis E, Fragkiadakis K, Kochiadakis G, Marketou M. Cardiac Remodeling and Ventricular Pacing: From Genes to Mechanics. Genes (Basel) 2024; 15:671. [PMID: 38927607 PMCID: PMC11203142 DOI: 10.3390/genes15060671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Revised: 05/17/2024] [Accepted: 05/21/2024] [Indexed: 06/28/2024] Open
Abstract
Cardiac remodeling and ventricular pacing represent intertwined phenomena with profound implications for cardiovascular health and therapeutic interventions. This review explores the intricate relationship between cardiac remodeling and ventricular pacing, spanning from the molecular underpinnings to biomechanical alterations. Beginning with an examination of genetic predispositions and cellular signaling pathways, we delve into the mechanisms driving myocardial structural changes and electrical remodeling in response to pacing stimuli. Insights into the dynamic interplay between pacing strategies and adaptive or maladaptive remodeling processes are synthesized, shedding light on the clinical implications for patients with various cardiovascular pathologies. By bridging the gap between basic science discoveries and clinical translation, this review aims to provide a comprehensive understanding of cardiac remodeling in the context of ventricular pacing, paving the way for future advancements in cardiovascular care.
Collapse
Affiliation(s)
- Onoufrios Malikides
- Department of Cardiology, University General Hospital of Heraklion, 71003 Heraklion, Greece; (E.S.); (E.Z.); (K.F.); (G.K.); (M.M.)
| | - Emmanouel Simantirakis
- Department of Cardiology, University General Hospital of Heraklion, 71003 Heraklion, Greece; (E.S.); (E.Z.); (K.F.); (G.K.); (M.M.)
- Medical School, University of Crete, 71003 Heraklion, Greece
| | - Evangelos Zacharis
- Department of Cardiology, University General Hospital of Heraklion, 71003 Heraklion, Greece; (E.S.); (E.Z.); (K.F.); (G.K.); (M.M.)
- Medical School, University of Crete, 71003 Heraklion, Greece
| | - Konstantinos Fragkiadakis
- Department of Cardiology, University General Hospital of Heraklion, 71003 Heraklion, Greece; (E.S.); (E.Z.); (K.F.); (G.K.); (M.M.)
- Medical School, University of Crete, 71003 Heraklion, Greece
| | - George Kochiadakis
- Department of Cardiology, University General Hospital of Heraklion, 71003 Heraklion, Greece; (E.S.); (E.Z.); (K.F.); (G.K.); (M.M.)
- Medical School, University of Crete, 71003 Heraklion, Greece
| | - Maria Marketou
- Department of Cardiology, University General Hospital of Heraklion, 71003 Heraklion, Greece; (E.S.); (E.Z.); (K.F.); (G.K.); (M.M.)
- Medical School, University of Crete, 71003 Heraklion, Greece
| |
Collapse
|
3
|
Schmitt A, Behnes M, Weidner K, Abumayyaleh M, Reinhardt M, Abel N, Lau F, Forner J, Ayoub M, Mashayekhi K, Akin I, Schupp T. Prognostic impact of prior LVEF in patients with heart failure with mildly reduced ejection fraction. Clin Res Cardiol 2024:10.1007/s00392-024-02443-0. [PMID: 38619579 DOI: 10.1007/s00392-024-02443-0] [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: 01/05/2024] [Accepted: 03/25/2024] [Indexed: 04/16/2024]
Abstract
AIMS As there is limited evidence regarding the prognostic impact of prior left ventricular ejection fraction (LVEF) in patients with heart failure with mildly reduced ejection fraction (HFmrEF), this study investigates the prognostic impact of longitudinal changes in LVEF in patients with HFmrEF. METHODS Consecutive patients with HFmrEF (i.e. LVEF 41-49% with signs and/or symptoms of HF) were included retrospectively in a monocentric registry from 2016 to 2022. Based on prior LVEF, patients were categorized into three groups: stable LVEF, improved LVEF, and deteriorated LVEF. The primary endpoint was 30-months all-cause mortality (median follow-up). Secondary endpoints included in-hospital and 12-months all-cause mortality, as well as HF-related rehospitalization at 12 and 30 months. Kaplan-Meier and multivariable Cox proportional regression analyses were applied for statistics. RESULTS Six hundred eighty-nine patients with HFmrEF were included. Compared to their prior LVEF, 24%, 12%, and 64% had stable, improved, and deteriorated LVEF, respectively. None of the three LVEF groups was associated with all-cause mortality at 12 (p ≥ 0.583) and 30 months (31% vs. 37% vs. 34%; log rank p ≥ 0.376). In addition, similar rates of 12- (p ≥ 0.533) and 30-months HF-related rehospitalization (21% vs. 23% vs. 21%; log rank p ≥ 0.749) were observed. These findings were confirmed in multivariable regression analyses in the entire study cohort. CONCLUSION The transition from HFrEF and HFpEF towards HFmrEF is very common. However, prior LVEF was not associated with prognosis, likely due to the persistently high dynamic nature of LVEF in the follow-up period.
Collapse
Affiliation(s)
- Alexander Schmitt
- First Department of Medicine, Section for Invasive Cardiology, University Medical Centre Mannheim (UMM), Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Michael Behnes
- First Department of Medicine, Section for Invasive Cardiology, University Medical Centre Mannheim (UMM), Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
| | - Kathrin Weidner
- First Department of Medicine, Section for Invasive Cardiology, University Medical Centre Mannheim (UMM), Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Mohammad Abumayyaleh
- First Department of Medicine, Section for Invasive Cardiology, University Medical Centre Mannheim (UMM), Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Marielen Reinhardt
- First Department of Medicine, Section for Invasive Cardiology, University Medical Centre Mannheim (UMM), Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Noah Abel
- First Department of Medicine, Section for Invasive Cardiology, University Medical Centre Mannheim (UMM), Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Felix Lau
- First Department of Medicine, Section for Invasive Cardiology, University Medical Centre Mannheim (UMM), Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Jan Forner
- First Department of Medicine, Section for Invasive Cardiology, University Medical Centre Mannheim (UMM), Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Mohamed Ayoub
- Division of Cardiology and Angiology, Heart Centre University of Bochum, Bad Oeynhausen, Germany
| | - Kambis Mashayekhi
- Department of Internal Medicine and Cardiology, Mediclin Heart Centre Lahr, Lahr, Germany
| | - Ibrahim Akin
- First Department of Medicine, Section for Invasive Cardiology, University Medical Centre Mannheim (UMM), Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Tobias Schupp
- First Department of Medicine, Section for Invasive Cardiology, University Medical Centre Mannheim (UMM), Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| |
Collapse
|
4
|
El-Chami MF, Garweg C, Clementy N, Al-Samadi F, Iacopino S, Martinez-Sande JL, Roberts PR, Tondo C, Johansen JB, Vinolas-Prat X, Cha YM, Grubman E, Bordachar P, Stromberg K, Fagan DH, Piccini JP. Leadless pacemakers at 5-year follow-up: the Micra transcatheter pacing system post-approval registry. Eur Heart J 2024; 45:1241-1251. [PMID: 38426911 PMCID: PMC10998730 DOI: 10.1093/eurheartj/ehae101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 01/04/2024] [Accepted: 02/05/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND AND AIMS Prior reports have demonstrated a favourable safety and efficacy profile of the Micra leadless pacemaker over mid-term follow-up; however, long-term outcomes in real-world clinical practice remain unknown. Updated performance of the Micra VR leadless pacemaker through five years from the worldwide post-approval registry (PAR) was assessed. METHODS All Micra PAR patients undergoing implant attempts were included. Endpoints included system- or procedure-related major complications and system revision rate for any cause through 60 months post-implant. Rates were compared through 36 months post-implant to a reference dataset of 2667 transvenous pacemaker patients using Fine-Gray competing risk models. RESULTS 1809 patients were enrolled between July 2015 and March 2018 and underwent implant attempts from 179 centres in 23 countries with a median follow-up period of 51.1 months (IQR: 21.6-64.2). The major complication rate at 60 months was 4.5% [95% confidence interval (CI): 3.6%-5.5%] and was 4.1% at 36 months, which was significantly lower than the 8.5% rate observed for transvenous systems (HR: .47, 95% CI: .36-.61; P < .001). The all-cause system revision rate at 60 months was 4.9% (95% CI: 3.9%-6.1%). System revisions among Micra patients were mostly for device upgrades (41.2%) or elevated thresholds (30.6%). There were no Micra removals due to infection noted over the duration of follow-up. At 36 months, the system revision rate was significantly lower with Micra vs. transvenous systems (3.2% vs. 6.6%, P < .001). CONCLUSIONS Long-term outcomes with the Micra leadless pacemaker continue to demonstrate low rates of major complications and system revisions and an extremely low incidence of infection.
Collapse
Affiliation(s)
- Mikhael F El-Chami
- Division of Cardiology, Section of Electrophysiology, Emory University, Atlanta, Georgia
| | - Christophe Garweg
- Department of Cardiovascular Sciences, Universitaire Ziekenhuizen Leuven, Leuven, Belgium
| | - Nicolas Clementy
- Department of Cardiologic Medicine, Centre Hospitalier Regional Universitaire de Tours—Hopital Trousseau, Tours, France
| | - Faisal Al-Samadi
- Department of Medicine, King Salman Heart Center—King Fahad Medical City, Riyadh, Saudi Arabia
| | - Saverio Iacopino
- Department of Clinical Electrophysiology & Cardiac Pacing, Centro Cardiologico Monzino, IRCCS, Department of Biomedical, Surgical, and Dental Sciences, University of Milan, Milan, Italy
| | - Jose Luis Martinez-Sande
- Arrhythmia Unit, Cardiology Service, University Clinical Hospital of Santiago de Compostela, CIBER-CV, IDIS, Santiago de Compostela, Spain
| | - Paul R Roberts
- Department of Medicine, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Claudio Tondo
- Monzino Cardiac Center, IRCCS, Department of Clinical Sciences and Community, University of Milan, Milan, Italy
| | | | | | - Yong-Mei Cha
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Eric Grubman
- Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Pierre Bordachar
- Cardio-Thoracic Unit, Bordeaux University Hospital, Pessac-Bordeaux, France
| | | | | | - Jonathan P Piccini
- Electrophysiology Section, Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA
| |
Collapse
|
5
|
Mannion J, Hong KL, Hennessey A, Cleary A, Subramaniyan A, Sheahan C, Bennett KE, Sheahan R. Optimizing Patient Selection for Physiological Pacing in Bradyarrhythmia: Factors Associated With High Ventricular Pacing Burden. Cardiol Res 2024; 15:99-107. [PMID: 38645828 PMCID: PMC11027784 DOI: 10.14740/cr1598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 03/05/2024] [Indexed: 04/23/2024] Open
Abstract
Background Right ventricular (RV) pacing is established as the most common ventricular pacing (VP) strategy for patients with symptomatic bradyarrhythmia. Some patients with high VP burden suffer deterioration of left ventricular (LV) function, termed pacing-induced cardiomyopathy (PICM). Patients who pace > 20% of the time from the RV apex are at increased risk of PICM, but independent predictors of increased RV pacing burden have not been elucidated in those who have a permanent pacemaker (PPM) inserted for bradyarrhythmia. Methods We aimed to identify factors that are associated with increased VP burden > 20%, hence determining those at risk for resultant PICM. In this retrospective cohort study, we identified the most recent 300 consecutive cardiac implantable electronic device (CIED) implants in our center and collected past medical history, electrocardiogram (ECG), echo, medication and pacemaker check data. Results A total of 236 individuals met inclusion criteria. Of the patients, 35% had RV pacing burden < 20%, while 65% had VP burden ≥ 20%; 96.2% of patients with complete heart block (CHB) paced > 20% (P = 0.002). Utilization of DDD or VVI (75.2% and 89.2% of patients, respectively) without mode switch algorithms was associated with VP > 20% (P < 0.001). Male or previous coronary artery bypass grafting (CABG) patients also statistically paced > 20%. Other factors trending towards significance included prolonged PR interval, atrial fibrillation or more advanced age. Conclusion High-grade atrioventricular (AV) block was associated with an RV pacing burden > 20% over 3 years but this was not consistent in patients with only transient episodes of high-grade AV block. We found a significant association between high VP% and male sex, previous CABG and the absence of mode switching algorithms.
Collapse
Affiliation(s)
- James Mannion
- Electrophysiology Department, Beaumont Hospital, Beaumont, Dublin 9, Ireland
| | - Kathryn L. Hong
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, Cambridgeshire, CB2 0QQ, UK
| | - Amy Hennessey
- Electrophysiology Department, Beaumont Hospital, Beaumont, Dublin 9, Ireland
| | - Anna Cleary
- Electrophysiology Department, Beaumont Hospital, Beaumont, Dublin 9, Ireland
| | - Anand Subramaniyan
- Electrophysiology Department, Beaumont Hospital, Beaumont, Dublin 9, Ireland
| | - Conor Sheahan
- Electrophysiology Department, Beaumont Hospital, Beaumont, Dublin 9, Ireland
- Royal College of Surgeons in Ireland, University of Medicine & Health Sciences, Dublin 2, Ireland
| | - Kathleen E. Bennett
- Data Science Centre, School of Population Health, RCSI, University of Medicine & Health Sciences, Dublin 2, Ireland
| | - Richard Sheahan
- Electrophysiology Department, Beaumont Hospital, Beaumont, Dublin 9, Ireland
- Royal College of Surgeons in Ireland, University of Medicine & Health Sciences, Dublin 2, Ireland
| |
Collapse
|
6
|
Oida M, Mizutani T, Hasumi E, Fujiu K, Goto K, Kani K, Oshima T, Matsubara TJ, Shimizu Y, Oguri G, Kojima T, Komuro I. Prediction of pacemaker-induced cardiomyopathy using a convolutional neural network based on clinical findings prior to pacemaker implantation. Sci Rep 2024; 14:6916. [PMID: 38519537 PMCID: PMC10959989 DOI: 10.1038/s41598-024-57418-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 03/18/2024] [Indexed: 03/25/2024] Open
Abstract
Risk factors for pacemaker-induced cardiomyopathy (PICM) have been previously reported, including a high burden of right ventricular pacing, lower left ventricular ejection fraction, a wide QRS duration, and left bundle branch block before pacemaker implantation (PMI). However, predicting the development of PICM remains challenging. This study aimed to use a convolutional neural network (CNN) model, based on clinical findings before PMI, to predict the development of PICM. Out of a total of 561 patients with dual-chamber PMI, 165 (mean age 71.6 years, 89 men [53.9%]) who underwent echocardiography both before and after dual-chamber PMI were enrolled. During a mean follow-up period of 1.7 years, 47 patients developed PICM. A CNN algorithm for prediction of the development of PICM was constructed based on a dataset prior to PMI that included 31 variables such as age, sex, body mass index, left ventricular ejection fraction, left ventricular end-diastolic diameter, left ventricular end-systolic diameter, left atrial diameter, severity of mitral regurgitation, severity of tricuspid regurgitation, ischemic heart disease, diabetes mellitus, hypertension, heart failure, New York Heart Association class, atrial fibrillation, the etiology of bradycardia (sick sinus syndrome or atrioventricular block) , right ventricular (RV) lead tip position (apex, septum, left bundle, His bundle, RV outflow tract), left bundle branch block, QRS duration, white blood cell count, haemoglobin, platelet count, serum total protein, albumin, aspartate transaminase, alanine transaminase, estimated glomerular filtration rate, sodium, potassium, C-reactive protein, and brain natriuretic peptide. The accuracy, sensitivity, specificity, and area under the curve of the CNN model were 75.8%, 55.6%, 83.3% and 0.78 respectively. The CNN model could accurately predict the development of PICM using clinical findings before PMI. This model could be useful for screening patients at risk of developing PICM, ensuring timely upgrades to physiological pacing to avoid missing the optimal intervention window.
Collapse
Affiliation(s)
- Mitsunori Oida
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo, Tokyo, 113-8655, Japan
| | - Takuya Mizutani
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Eriko Hasumi
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo, Tokyo, 113-8655, Japan.
| | - Katsuhito Fujiu
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo, Tokyo, 113-8655, Japan
- Department of Advanced Cardiology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kosaku Goto
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo, Tokyo, 113-8655, Japan
| | - Kunihiro Kani
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo, Tokyo, 113-8655, Japan
| | - Tsukasa Oshima
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo, Tokyo, 113-8655, Japan
| | - Takumi J Matsubara
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo, Tokyo, 113-8655, Japan
| | - Yu Shimizu
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo, Tokyo, 113-8655, Japan
| | - Gaku Oguri
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo, Tokyo, 113-8655, Japan
| | - Toshiya Kojima
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo, Tokyo, 113-8655, Japan
| | - Issei Komuro
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo, Tokyo, 113-8655, Japan
| |
Collapse
|
7
|
Eaves S, Lipton JA. Global longitudinal strain as a risk factor for pacing-induced cardiomyopathy: another step toward mechanistic insight and prevention strategies. J Interv Card Electrophysiol 2024; 67:241-242. [PMID: 38055161 DOI: 10.1007/s10840-023-01701-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 11/19/2023] [Indexed: 12/07/2023]
Affiliation(s)
- Scott Eaves
- Royal Hobart Hospital, Hobart, TAS, Australia
| | - Jonathan A Lipton
- Royal Hobart Hospital, Hobart, TAS, Australia.
- Royal Melbourne Hospital, Victoria, Australia.
- University of Tasmania, Tasmania, Australia.
| |
Collapse
|
8
|
Ponnusamy SS, Vijayaraman P. Pacing for atrioventricular block with preserved left ventricular function: On-treatment comparison between his bundle, left bundle branch, and right ventricular pacing. Indian Pacing Electrophysiol J 2023; 23:196-202. [PMID: 37776973 PMCID: PMC10685102 DOI: 10.1016/j.ipej.2023.09.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 09/03/2023] [Accepted: 09/21/2023] [Indexed: 10/02/2023] Open
|
9
|
Oida M, Hasumi E, Kohsaku G, Kunihiro K, Oshima T, Matsubara TJ, Matsuda J, Shimizu Y, Oguri G, Kojima T, Fujiu K, Komuro I. The estimated glomerular filtration rate predicts pacemaker-induced cardiomyopathy. Sci Rep 2023; 13:16514. [PMID: 37783787 PMCID: PMC10545821 DOI: 10.1038/s41598-023-43953-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 09/30/2023] [Indexed: 10/04/2023] Open
Abstract
Clinical predictors for pacemaker-induced cardiomyopathy (PICM) (e.g., a wide QRS duration and left bundle branch block at baseline) have been reported. However, factors involved in the development of PICM in patients with preserved left ventricular ejection fraction (LVEF) remain unknown. This study aimed to determine the risk factors for PICM in patients with preserved LVEF. The data of 113 patients (average age: 71.3 years; men: 54.9%) who had echocardiography before and after pacemaker implantation (PMI) among 465 patients undergoing dual-chamber PMI were retrospectively analyzed. Thirty-three patients were diagnosed with PICM (18.0/100 person-years; 95% CI 12.8-25.2). A univariate Cox regression analysis showed that an estimated glomerular filtration rate (eGFR) ≤ 30 mL/min/1.73 m2 (HR 3.47; 95% CI 1.48-8.16) and a past medical history of coronary artery disease (CAD) (HR 2.76; 95% CI 1.36-5.60) were significantly associated with the onset of PICM. After adjusting for clinical variables, an eGFR ≤ 30 mL/min/1.73 m2 (HR 2.62; 95% CI 1.09-6.29) and a medical history of CAD (HR 2.32; 95% CI 1.13-4.80) were independent risk factors for developing PICM. A medical history of CAD and low eGFR are independent risk factors for PICM in patients with preserved LVEF at baseline. These results could be helpful in predicting a decreased LVEF by ventricular pacing before PMI. Close follow-up by echocardiography is recommended to avoid a delay in upgrading to physiological pacing, such as cardiac resynchronization therapy or conduction system pacing.
Collapse
Affiliation(s)
- Mitsunori Oida
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo, Tokyo, 113-8655, Japan
| | - Eriko Hasumi
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo, Tokyo, 113-8655, Japan.
| | - Goto Kohsaku
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo, Tokyo, 113-8655, Japan
| | - Kani Kunihiro
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo, Tokyo, 113-8655, Japan
| | - Tsukasa Oshima
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo, Tokyo, 113-8655, Japan
| | - Takumi J Matsubara
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo, Tokyo, 113-8655, Japan
| | - Jun Matsuda
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo, Tokyo, 113-8655, Japan
| | - Yu Shimizu
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo, Tokyo, 113-8655, Japan
| | - Gaku Oguri
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo, Tokyo, 113-8655, Japan
| | - Toshiya Kojima
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo, Tokyo, 113-8655, Japan
| | - Katsuhito Fujiu
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo, Tokyo, 113-8655, Japan.
- Department of Advanced Cardiology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
| | - Issei Komuro
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo, Tokyo, 113-8655, Japan
| |
Collapse
|
10
|
Chung MK, Patton KK, Lau C, Dal Forno ARJ, Al‐Khatib SM, Arora V, Birgersdotter‐Green UM, Cha Y, Chung EH, Cronin EM, Curtis AB, Cygankiewicz I, Dandamudi G, Dubin AM, Ensch DP, Glotzer TV, Gold MR, Goldberger ZD, Gopinathannair R, Gorodeski EZ, Gutierrez A, Guzman JC, Huang W, Imrey PB, Indik JH, Karim S, Karpawich PP, Khaykin Y, Kiehl EL, Kron J, Kutyifa V, Link MS, Marine JE, Mullens W, Park S, Parkash R, Patete MF, Pathak RK, Perona CA, Rickard J, Schoenfeld MH, Seow S, Shen W, Shoda M, Singh JP, Slotwiner DJ, Sridhar ARM, Srivatsa UN, Stecker EC, Tanawuttiwat T, Tang WHW, Tapias CA, Tracy CM, Upadhyay GA, Varma N, Vernooy K, Vijayaraman P, Worsnick SA, Zareba W, Zeitler EP, Lopez‐Cabanillas N, Ellenbogen KA, Hua W, Ikeda T, Mackall JA, Mason PK, McLeod CJ, Mela T, Moore JP, Racenet LK. 2023 HRS/APHRS/LAHRS guideline on cardiac physiologic pacing for the avoidance and mitigation of heart failure. J Arrhythm 2023; 39:681-756. [PMID: 37799799 PMCID: PMC10549836 DOI: 10.1002/joa3.12872] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/07/2023] Open
Abstract
Cardiac physiologic pacing (CPP), encompassing cardiac resynchronization therapy (CRT) and conduction system pacing (CSP), has emerged as a pacing therapy strategy that may mitigate or prevent the development of heart failure (HF) in patients with ventricular dyssynchrony or pacing-induced cardiomyopathy. This clinical practice guideline is intended to provide guidance on indications for CRT for HF therapy and CPP in patients with pacemaker indications or HF, patient selection, pre-procedure evaluation and preparation, implant procedure management, follow-up evaluation and optimization of CPP response, and use in pediatric populations. Gaps in knowledge, pointing to new directions for future research, are also identified.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | - Anne M. Dubin
- Stanford University, Pediatric CardiologyPalo AltoCaliforniaUSA
| | | | - Taya V. Glotzer
- Hackensack Meridian School of MedicineHackensackNew JerseyUSA
| | - Michael R. Gold
- Medical University of South CarolinaCharlestonSouth CarolinaUSA
| | | | | | - Eiran Z. Gorodeski
- University Hospitals and Case Western Reserve University School of MedicineClevelandOhioUSA
| | | | | | - Weijian Huang
- First Affiliated Hospital of Wenzhou Medical UniversityWenzhouChina
| | - Peter B. Imrey
- Cleveland ClinicClevelandOhioUSA
- Case Western Reserve UniversityClevelandOhioUSA
| | - Julia H. Indik
- University of Arizona, Sarver Heart CenterTucsonArizonaUSA
| | - Saima Karim
- MetroHealth Medical CenterCase Western Reserve UniversityClevelandOhioUSA
| | - Peter P. Karpawich
- The Children's Hospital of MichiganCentral Michigan UniversityDetroitMichiganUSA
| | | | | | - Jordana Kron
- Virginia Commonwealth UniversityRichmondVirginiaUSA
| | | | - Mark S. Link
- University of Texas Southwestern Medical CenterDallasTexasUSA
| | | | - Wilfried Mullens
- Ziekenhuis Oost‐Limburg GenkBelgium and Hasselt UniversityHasseltBelgium
| | - Seung‐Jung Park
- Sungkyunkwan University School of Medicine, Samsung Medical CenterSeoulRepublic of Korea
| | | | | | - Rajeev Kumar Pathak
- Australian National University, Canberra HospitalGarranAustralian Capital TerritoryAustralia
| | | | | | | | | | | | | | - Jagmeet P. Singh
- Massachusetts General Hospital, Harvard Medical SchoolBostonMassachusettsUSA
| | | | | | | | | | | | | | | | | | | | | | - Kevin Vernooy
- Cardiovascular Research Institute Maastricht, Maastricht University Medical CenterMaastrichtThe Netherlands
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
11
|
Chung MK, Patton KK, Lau CP, Dal Forno ARJ, Al-Khatib SM, Arora V, Birgersdotter-Green UM, Cha YM, Chung EH, Cronin EM, Curtis AB, Cygankiewicz I, Dandamudi G, Dubin AM, Ensch DP, Glotzer TV, Gold MR, Goldberger ZD, Gopinathannair R, Gorodeski EZ, Gutierrez A, Guzman JC, Huang W, Imrey PB, Indik JH, Karim S, Karpawich PP, Khaykin Y, Kiehl EL, Kron J, Kutyifa V, Link MS, Marine JE, Mullens W, Park SJ, Parkash R, Patete MF, Pathak RK, Perona CA, Rickard J, Schoenfeld MH, Seow SC, Shen WK, Shoda M, Singh JP, Slotwiner DJ, Sridhar ARM, Srivatsa UN, Stecker EC, Tanawuttiwat T, Tang WHW, Tapias CA, Tracy CM, Upadhyay GA, Varma N, Vernooy K, Vijayaraman P, Worsnick SA, Zareba W, Zeitler EP. 2023 HRS/APHRS/LAHRS guideline on cardiac physiologic pacing for the avoidance and mitigation of heart failure. Heart Rhythm 2023; 20:e17-e91. [PMID: 37283271 PMCID: PMC11062890 DOI: 10.1016/j.hrthm.2023.03.1538] [Citation(s) in RCA: 131] [Impact Index Per Article: 131.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 03/31/2023] [Indexed: 06/08/2023]
Abstract
Cardiac physiologic pacing (CPP), encompassing cardiac resynchronization therapy (CRT) and conduction system pacing (CSP), has emerged as a pacing therapy strategy that may mitigate or prevent the development of heart failure (HF) in patients with ventricular dyssynchrony or pacing-induced cardiomyopathy. This clinical practice guideline is intended to provide guidance on indications for CRT for HF therapy and CPP in patients with pacemaker indications or HF, patient selection, pre-procedure evaluation and preparation, implant procedure management, follow-up evaluation and optimization of CPP response, and use in pediatric populations. Gaps in knowledge, pointing to new directions for future research, are also identified.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | - Eugene H Chung
- University of Michigan Medical School, Ann Arbor, Michigan
| | | | | | | | | | - Anne M Dubin
- Stanford University, Pediatric Cardiology, Palo Alto, California
| | | | - Taya V Glotzer
- Hackensack Meridian School of Medicine, Hackensack, New Jersey
| | - Michael R Gold
- Medical University of South Carolina, Charleston, South Carolina
| | - Zachary D Goldberger
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | | | - Eiran Z Gorodeski
- University Hospitals and Case Western Reserve University School of Medicine, Cleveland, Ohio
| | | | | | - Weijian Huang
- First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Peter B Imrey
- Cleveland Clinic, Cleveland, Ohio; Case Western Reserve University, Cleveland, Ohio
| | - Julia H Indik
- University of Arizona, Sarver Heart Center, Tucson, Arizona
| | - Saima Karim
- MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio
| | - Peter P Karpawich
- The Children's Hospital of Michigan, Central Michigan University, Detroit, Michigan
| | - Yaariv Khaykin
- Southlake Regional Health Center, Newmarket, Ontario, Canada
| | | | - Jordana Kron
- Virginia Commonwealth University, Richmond, Virginia
| | | | - Mark S Link
- University of Texas Southwestern Medical Center, Dallas, Texas
| | - Joseph E Marine
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Wilfried Mullens
- Ziekenhuis Oost-Limburg Genk, Belgium and Hasselt University, Hasselt, Belgium
| | - Seung-Jung Park
- Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Republic of Korea
| | - Ratika Parkash
- QEII Health Sciences Center, Halifax, Nova Scotia, Canada
| | | | - Rajeev Kumar Pathak
- Australian National University, Canberra Hospital, Garran, Australian Capital Territory, Australia
| | | | | | | | | | | | - Morio Shoda
- Tokyo Women's Medical University, Tokyo, Japan
| | - Jagmeet P Singh
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - David J Slotwiner
- Weill Cornell Medicine Population Health Sciences, New York, New York
| | | | | | | | | | | | | | - Cynthia M Tracy
- George Washington University, Washington, District of Columbia
| | | | | | - Kevin Vernooy
- Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, Maastricht, The Netherlands
| | | | | | | | | |
Collapse
|
12
|
Abstract
Right ventricle (RV) apex continues to remain as the standard pacing site in the ventricle due to ease of implantation, procedural safety and lack of convincing evidence of better clinical outcomes from non-apical pacing sites. Electrical dyssynchrony resulting in abnormal ventricular activation and mechanical dyssynchrony resulting in abnormal ventricular contraction during RV pacing can result in adverse LV remodelling predisposing some patients for recurrent heart failure (HF) hospitalisation, atrial arrhythmias and increased mortality. While there are significant variations in the definition of pacing induced cardiomyopathy (PIC), combining both echocardiographic and clinical features, the most acceptable definition for PIC would be left ventricular ejection fraction (LVEF) of <50%, absolute decline of LVEF by ≥10% and/or new-onset HF symptoms or atrial fibrillation (AF) after pacemaker implantation. Based on the definitions used, the prevalence of PIC varies between 6% and 25% with overall pooled prevalence of 12%. While most patients undergoing RV pacing do not develop PIC, male sex, chronic kidney disease, previous myocardial infarction, pre-existing AF, baseline LVEF, native QRS duration, RV pacing burden, and paced QRS duration are the factors associated with increased risk for PIC. While conduction system pacing (CSP) using His bundle pacing and left bundle branch pacing appear to reduce the risk for PIC compared with RV pacing, both biventricular pacing and CSP may be used to effectively reverse PIC.
Collapse
Affiliation(s)
- Shunmuga Sundaram Ponnusamy
- Division of Cardiology, Velammal Medical College Hospital and Research Institute, Madurai, Tamil Nadu, India
| | - Thabish Syed
- Division of Cardiology, Velammal Medical College Hospital and Research Institute, Madurai, Tamil Nadu, India
| | - Pugazhendhi Vijayaraman
- Geisinger Heart Institute, Geisinger Commonwealth School of Medicine, Wilkes-Barre, Pennsylvania, USA
| |
Collapse
|
13
|
Padala SK, Ellenbogen KA. Pacing of Specialized Conduction System. Cardiol Clin 2023; 41:463-489. [PMID: 37321695 DOI: 10.1016/j.ccl.2023.03.005] [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: 06/17/2023]
Abstract
Right ventricular pacing for bradycardia remains the mainstay of pacing therapy. Chronic right ventricular pacing may lead to pacing-induced cardiomyopathy. We focus on the anatomy of the conduction system and the clinical feasibility of pacing the His bundle and/or left bundle conduction system. We review the hemodynamics of conduction system pacing, the techniques to capture the conduction system and the electrocardiogram and pacing definitions of conduction system capture. Clinical studies of conduction system pacing in the setting of atrioventricular block and after AV junction ablation are reviewed and the evolving role of conduction system pacing is compared with biventricular pacing.
Collapse
Affiliation(s)
- Santosh K Padala
- Department of Cardiac Electrophysiology, Virginia Commonwealth University, Gateway Building, 3 Road Floor, 3-216, 1200 East Marshall Street, Richmond, VA, USA
| | - Kenneth A Ellenbogen
- Department of Cardiac Electrophysiology, Virginia Commonwealth University, Gateway Building, 3 Road Floor, 3-216, 1200 East Marshall Street, Richmond, VA, USA.
| |
Collapse
|
14
|
Khurshid S, Frankel DS. Pacing-Induced Cardiomyopathy. Cardiol Clin 2023; 41:449-461. [PMID: 37321694 PMCID: PMC11194687 DOI: 10.1016/j.ccl.2023.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Right ventricular (RV) pacing-induced cardiomyopathy (PICM) is typically defined as left ventricular systolic dysfunction resulting from electrical and mechanical dyssynchrony caused by RV pacing. RV PICM is common, occurring in 10-20% of individuals exposed to frequent RV pacing. Multiple risk factors for PICM have been identified, including male sex, wider native and paced QRS durations, and higher RV pacing percentage, but the ability to predict which individuals will develop PICM remains modest. Biventricular and conduction system pacing, which better preserve electrical and mechanical synchrony, typically prevent the development of PICM and reverse left ventricular systolic dysfunction after PICM has occurred.
Collapse
Affiliation(s)
- Shaan Khurshid
- Division of Cardiology and Cardiovascular Research Center, Massachusetts General Hospital, Yawkey 5B Heart Center, 55 Fruit Street, Boston, MA 02114, USA
| | - David S Frankel
- Cardiovascular Division, Perelman School of Medicine at the University of Pennsylvania, 3400 Spruce Street, 9 Founders Pavilion, Philadelphia, PA 19104, USA.
| |
Collapse
|
15
|
Saeed Al-Asad K, Martinez A, Prasad RM, Ukponmwan EU, Baloch ZQ, Ali A, Ip J. Pacing-Induced Cardiomyopathy in Leadless and Traditional Pacemakers: A Single-Center Retrospective Analysis. Cureus 2023; 15:e41393. [PMID: 37416086 PMCID: PMC10320824 DOI: 10.7759/cureus.41393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/05/2023] [Indexed: 07/08/2023] Open
Abstract
BACKGROUND Pacing-induced cardiomyopathy (PICM) is a clinical syndrome that is characterized by a drop in the left ventricular ejection fraction (LVEF) due to chronic high-burden right ventricular (RV) pacing. It has been postulated that leadless pacemakers (LPs) cause decreased risk of PICM compared to transvenous pacemakers (TVPs), but the exact risk reduction is unknown. METHODS We performed a single-center retrospective analysis of adults who received an LP or TVP between January 1, 2014, and April 1, 2022, and had echocardiograms before and after the pacemaker implant. This study's outcomes were the RV pacing percentage, change in EF, the need for cardiac resynchronization therapy (CRT) upgrade, and follow-up duration. A Wilcoxon rank-sum test calculated the change in EF. RV time, defined as the duration from pacemaker placement to the follow-up echocardiogram in months multiplied by the RV pacing percentage, served as a surrogate for how long the RV was paced. RESULTS A total of 614 patients were screened, and 198 patients were included in the study, where 72 received LP and 126 received TVP. The median follow-up was 480 days. The average of the reported RV percentage pacing was 63.43% for LP and 71.30% for TVP (p=0.14). The incidence of PICM and CRT upgrade was 44% and 9.7% in the LP group and 37% and 9.5% in the TVP group (p=0.3 and p>0.9), respectively. After accounting for age, sex, LP versus TVP, atrioventricular nodal ablation, RV pacing percentage, and follow-up duration, univariate analysis showed that RV time was significantly different between the two types of pacemakers (13.54 ± 14.21 months (LP) versus 9.26 ± 13.95 months (TVP), p=0.009). The difference in RV time between patients who underwent CRT upgrade and those who did not was statistically insignificant (12.11 ± 14.47 months (no CRT) versus 9.19 ± 12.00 months (CRT), p=0.5). CONCLUSIONS This analysis demonstrated that the incidence of PICM was high in both groups (44% (LP) versus 37% (TVP)), despite significantly more RV time in patients with LP. There was no difference in CRT upgrade between LP and TVP.
Collapse
Affiliation(s)
| | - Adolfo Martinez
- Department of Internal Medicine, Michigan State University, East Lansing, USA
| | - Rohan M Prasad
- Department of Cardiology, Sparrow Hospital, Lansing, USA
| | - Esosa U Ukponmwan
- Department of Internal Medicine, Michigan State University, East Lansing, USA
| | | | - Abbas Ali
- Department of Cardiology, West Virginia University, Morgantown, USA
| | - John Ip
- Department of Cardiology, Sparrow Hospital, Lansing, USA
| |
Collapse
|
16
|
Shantha G, Brock J, Singleton M, Kozak P, Bodziock G, Bradford N, Deshmukh A, Liang JJ, Pothineni NVK, Hranitzky P, Whalen P, Bhave PD. Anatomical location of leadless pacemaker and the risk of pacing-induced cardiomyopathy. J Cardiovasc Electrophysiol 2023; 34:1418-1426. [PMID: 37161942 DOI: 10.1111/jce.15925] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 03/30/2023] [Accepted: 04/29/2023] [Indexed: 05/11/2023]
Abstract
BACKGROUND It is unclear if the location of implantation of the leadless pacemaker (LP) makes a difference in the incidence of pacing-induced cardiomyopathy (PICM). AIM The aim of this study was to compare the incidence of PICM based on the location of implantation of LP. METHODS A total of 358 consecutive patients [women: 171 (48%), mean age: 73 ± 15 years] with left ventricular ejection fraction (EF) > 50%, who received an LP (Micra) between January 2017 and June 2022, formed the study cohort. Micra-AV and Micra-VR were implanted in 122 (34%) and 236 (66%) patients, respectively. Fluoroscopically, the location of implantation of LP in the interventricular septum (IS) was divided into two equal halves (apex/apical septum [AS] and mid/high septum [HS]). During follow-up, PICM was defined as an EF drop of ≥10%. RESULTS LP was implanted in 109 (34%) and 249 (66%) patients at AS and HS locations, respectively. During a mean 18 ± 8 months follow-up, 28 patients (7.8%) developed PICM. Among the 249 patients with HS placement of LP, 10 (4%) developed PICM, whereas among the 109 patients with AS placement of LP, 18 (16.5%) developed PICM (p = .002). AS location was associated with a higher risk of PICM compared to HS locations (adjusted hazard ratio: 4.42, p < .001). CONCLUSION AS location of LP was associated with a higher risk of PICM compared to HS placement. Larger randomized studies are needed to confirm our findings.
Collapse
Affiliation(s)
- Ghanshyam Shantha
- Department of Cardiac Electrophysiology, Wake Forest University, Winston-Salem, North Carolina, USA
| | - Jonathan Brock
- Department of Cardiac Electrophysiology, Wake Forest University, Winston-Salem, North Carolina, USA
| | | | - Patrick Kozak
- Department of Cardiac Electrophysiology, Wake Forest University, Winston-Salem, North Carolina, USA
| | - George Bodziock
- Department of Cardiac Electrophysiology, Wake Forest University, Winston-Salem, North Carolina, USA
| | - Natalie Bradford
- Department of Cardiac Electrophysiology, Wake Forest University, Winston-Salem, North Carolina, USA
| | - Abhishek Deshmukh
- Department of Cardiac Electrophysiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Jackson J Liang
- Department of Cardiac Electrophysiology, University of Michigan, Ann Arbor, Michigan, USA
| | | | - Patrick Hranitzky
- Department of Cardiac, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Patrick Whalen
- Department of Cardiac Electrophysiology, Wake Forest University, Winston-Salem, North Carolina, USA
| | - Prashant D Bhave
- Department of Cardiac Electrophysiology, Wake Forest University, Winston-Salem, North Carolina, USA
| |
Collapse
|
17
|
Feasibility and safety of both His bundle pacing and left bundle branch area pacing in atrial fibrillation patients: intermediate term follow-up. J Interv Card Electrophysiol 2023; 66:271-280. [PMID: 33723691 DOI: 10.1007/s10840-021-00964-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Accepted: 02/07/2021] [Indexed: 12/24/2022]
Abstract
PURPOSE His bundle pacing (HBP) improves heart failure (HF) in atrial fibrillation (AF) pacing-dependent patients with a potential for a progressively increased threshold. HBP with right ventricular pacing (RVP) as a backup is always the preferred choice; however, RVP may induce HF. His Purkinje system pacing (HPSP) includes HBP and left bundle branch area pacing (LBBAP). LBBAP maintains left ventricular synchrony but has not been proven to be safe over the long term. We assessed the feasibility and safety of both HBP and LBBAP in AF pacing-dependent patients and compared the parameters of both leads at baseline and at the 6-month follow-up. METHODS A total of 16 AF patients in our center, who successfully attempted both HBP and LBBAP, were prospectively enrolled unless only one of these treatment statuses was attained. The electrocardiogram characteristics, leading parameters, echocardiography results, and clinical outcomes were assessed. RESULTS Thirteen out of 16 patients achieved both HBP and LBBAP successfully in the same AF pacing-dependent patients. In symptomatic HF patients with preserved left ventricular ejection fraction (LVEF) (n = 10), the left ventricular end-diastolic diameter (LVEDD) was reduced from 51.8 ± 4.4 to 48.3 ± 3.1 mm (p = 0.01) with the use of diuretics, either reduced or stopped (n = 7). During the follow-up, one patient in the group without HF had an increased HBP threshold and developed HF symptoms. His HF symptoms disappeared when switched into LBBAP mode. Another patient in the group with HF got his LVEF elevated by HBP for 3 months by utilizing left bundle branch block(LBBB)correction and continued to increase when switched into LBBAP for another 3 months due to an increased HBP correction threshold. The average unipolar pacing threshold of LBBAP was lower than that of HBP. No perforation or dislodgement occurred in our study. CONCLUSION Both HBP and LBBAP could be attempted successfully in the same AF patients when one of the two modes could be adopted and switched according to the clinical feasibility. Compared with HBP, LBBAP yielded better and more stable parameters but showed comparable effects during the 6-month follow-up.
Collapse
|
18
|
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.
Collapse
|
19
|
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.
Collapse
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
| |
Collapse
|
20
|
Thiyagarajah A, Evans S, Lau DH. Editorial commentary: Pursuing the holy grail of cardiac pacing. Trends Cardiovasc Med 2023; 33:123-124. [PMID: 34986427 DOI: 10.1016/j.tcm.2021.12.017] [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: 12/27/2021] [Accepted: 12/29/2021] [Indexed: 02/07/2023]
Affiliation(s)
- Anand Thiyagarajah
- Department of Cardiology, Royal Adelaide Hospital and Centre for Heart Rhythm Disorders, The University of Adelaide, 1 Port Rd, Adelaide, SA 5000, Australia
| | - Shaun Evans
- Department of Cardiology, Royal Adelaide Hospital and Centre for Heart Rhythm Disorders, The University of Adelaide, 1 Port Rd, Adelaide, SA 5000, Australia
| | - Dennis H Lau
- Department of Cardiology, Royal Adelaide Hospital and Centre for Heart Rhythm Disorders, The University of Adelaide, 1 Port Rd, Adelaide, SA 5000, Australia.
| |
Collapse
|
21
|
Khan Z, Rayner T, Sethumadhavan D, Kyaw S. A Case Report of Pacemaker-Induced Cardiomyopathy in a Patient With Post-atrioventricular Node Ablation for Atrial Fibrillation. Cureus 2023; 15:e33930. [PMID: 36814737 PMCID: PMC9940130 DOI: 10.7759/cureus.33930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2023] [Indexed: 01/20/2023] Open
Abstract
Pacemaker-induced cardiomyopathy (PICM) is a rare but well-recognised phenomenon in patients requiring right ventricular (RV) pacing. It can be caused by single-chamber or dual-chamber pacemakers. We present a case of a 64-year-old female patient presenting to the pacemaker clinic with worsening shortness of breath and legs swelling. She was found to have atrial fibrillation and underwent atrioventricular node ablation followed by a dual chamber permanent pacemaker (PPM) implantation as part of a 'pace and ablate' strategy to treat refractory symptomatic atrial tachycardia, and the patient was entirely dependent on RV pacing. In the immediate two months following PPM implantation, the patient was seen in the clinic and reported shortness of breath that was attributed to interstitial lung disease. However, a month later her symptoms worsened, stimulating a referral for echocardiography, which demonstrated a fall in her left ventricular ejection fraction (LVEF) from 60% to 30% in just four months after the device implantation. The patient was diagnosed with PICM. The patient's prognostic heart failure treatment was optimised and her device was upgraded to a cardiac resynchronisation (CRT) device with pacing functionality in an attempt to improve biventricular synchrony. The patient's symptoms have improved significantly since and a repeat echocardiogram 2 months later showed significant improvement in LVEF to 45-50%.
Collapse
Affiliation(s)
- Zahid Khan
- Acute Medicine, Mid and South Essex NHS Foundation Trust, Southend on Sea, GBR
- Cardiology, Bart's Heart UK, London, GBR
- Cardiology and General Medicine, Barking, Havering and Redbridge University Hospitals NHS Trust, London, GBR
- Cardiology, Royal Free Hospital, London, GBR
| | - Tom Rayner
- Cardiology, Barts Heart Centre, London, GBR
| | | | - Sithu Kyaw
- Cardiology, Barts Heart Centre, London, GBR
| |
Collapse
|
22
|
Risk of Pacing-Induced Cardiomyopathy in Patients with High-Degree Atrioventricular Block-Impact of Right Ventricular Lead Position Confirmed by Computed Tomography. J Clin Med 2022; 11:jcm11237228. [PMID: 36498801 PMCID: PMC9735633 DOI: 10.3390/jcm11237228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 11/28/2022] [Accepted: 12/02/2022] [Indexed: 12/12/2022] Open
Abstract
Prospective studies applying fluoroscopy for assessment of right ventricular (RV) lead position have failed to show clear benefits from RV septal pacing. We investigated the impact of different RV lead positions verified by computed tomography (CT) on the risk of pacing-induced cardiomyopathy (PICM). We retrospectively included 153 patients who underwent routine fluoroscopy-guided pacemaker implantation between March 2012 and May 2020. All patients had normal pre-implant left ventricular ejection fraction (LVEF). Patients attended a follow-up visit including contrast-enhanced cardiac CT and transthoracic echocardiography. Patients were classified as septal or non-septal based on CT analysis. The primary endpoint was PICM (LVEF < 50% with ≥10% decrease after implantation). Based on CT, 48 (31.4%) leads were septal and 105 (68.6%) were non-septal. Over a median follow-up of 3.1 years, 16 patients (33.3%) in the septal group developed PICM compared to 31 (29.5%) in the non-septal group (p = 0.6). Overall, 13.1% deteriorated to LVEF ≤ 40%, 5.9% were upgraded to cardiac resynchronization therapy device, and 14.4% developed new-onset atrial fibrillation, with no significant differences between the groups. This study demonstrated a high risk of PICM despite normal pre-implant left ventricular systolic function with no significant difference between CT-verified RV septal or non-septal lead position.
Collapse
|
23
|
Mizner J, Jurak P, Linkova H, Smisek R, Curila K. Ventricular Dyssynchrony and Pacing-induced Cardiomyopathy in Patients with Pacemakers, the Utility of Ultra-high-frequency ECG and Other Dyssynchrony Assessment Tools. Arrhythm Electrophysiol Rev 2022; 11:e17. [PMID: 35990106 PMCID: PMC9376832 DOI: 10.15420/aer.2022.01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Accepted: 04/09/2022] [Indexed: 11/23/2022] Open
Abstract
The majority of patients tolerate right ventricular pacing well; however, some patients manifest signs of heart failure after pacemaker implantation and develop pacing-induced cardiomyopathy. This is a consequence of non-physiological ventricular activation bypassing the conduction system. Ventricular dyssynchrony was identified as one of the main factors responsible for pacing-induced cardiomyopathy development. Currently, methods that would allow rapid and reliable ventricular dyssynchrony assessment, ideally during the implant procedure, are lacking. Paced QRS duration is an imperfect marker of dyssynchrony, and methods based on body surface mapping, electrocardiographic imaging or echocardiography are laborious and time-consuming, and can be difficult to use during the implantation procedure. However, the ventricular activation sequence can be readily displayed from the chest leads using an ultra-high-frequency ECG. It can be performed during the implantation procedure to visualise ventricular depolarisation and resultant ventricular dyssynchrony during pacing. This information can assist the electrophysiologist in selecting a pacing location that avoids dyssynchronous ventricular activation.
Collapse
Affiliation(s)
- Jan Mizner
- Department of Cardiology, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Pavel Jurak
- Institute of Scientific Instruments of the Czech Academy of Sciences, Brno, Czech Republic
| | - Hana Linkova
- Department of Cardiology, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Radovan Smisek
- Institute of Scientific Instruments of the Czech Academy of Sciences, Brno, Czech Republic
| | - Karol Curila
- Department of Cardiology, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Prague, Czech Republic
| |
Collapse
|
24
|
Rademakers LM, Bouwmeester S, Mast TP, Dekker L, Houthuizen P, Bracke FA. Feasibility, safety and outcomes of upgrading to left bundle branch pacing in patients with right ventricular pacing induced cardiomyopathy. Pacing Clin Electrophysiol 2022; 45:726-732. [PMID: 35510824 DOI: 10.1111/pace.14515] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 04/13/2022] [Accepted: 04/29/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Right ventricular pacing (RVP) induces abnormal electrical activation and asynchronous ventricular contraction and leads to pacing induced cardiomyopathy (PICM) in 10-20% of patients. Cardiac resynchronization therapy (CRT) utilizing biventricular pacing (BVP) is the recommended treatment. Left bundle branch pacing (LBBP) is a novel physiological pacing technique which may serve as an alternative to CRT. This study assessed feasibility and outcomes of LBBP delivered CRT in patients with PICM. METHODS Twenty consecutive patients with PICM who received an upgrade of their pacemaker to LBBP were prospectively studied. Acute success rate, complications, functional and echocardiographic response and hospitalization for heart failure within six months from implantation were evaluated. RESULTS LBBP was successfully delivered in all patients. Median duration of RVP before upgrade to LBBP was 3.8 years and the RVP percentage was 99. LBBP resulted in significant QRS narrowing (from 193 ± 18 to 130 ± 17 ms (p<0.001)), improvement in LVEF (from 32 ± 6 percent to 47 ± 8 percent (p<0.001)) and NYHA class (from 2.8 ± 0.4 to 1.4 ± 0.5 (p<0.001)) at 6 months. No LBBP-related complications occurred. No patients were hospitalized for heart failure or died. CONCLUSION LBBP is feasible and safe in delivering CRT in PICM. Preliminary analyses demonstrated significant electrical resynchronization and favourable improvement in LV function and NYHA functional class at short term follow-up. Data need to be validated in large randomized controlled trials. This article is protected by copyright. All rights reserved.
Collapse
Affiliation(s)
| | - Sjoerd Bouwmeester
- Department of Cardiology, Catharina Hospital, Eindhoven, The Netherlands
| | - Thomas P Mast
- Department of Cardiology, Catharina Hospital, Eindhoven, The Netherlands
| | - Lukas Dekker
- Department of Cardiology, Catharina Hospital, Eindhoven, The Netherlands
| | - Patrick Houthuizen
- Department of Cardiology, Catharina Hospital, Eindhoven, The Netherlands
| | - Frank A Bracke
- Department of Cardiology, Catharina Hospital, Eindhoven, The Netherlands
| |
Collapse
|
25
|
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.
Collapse
|
26
|
Balli M, Çetin M, Koksal F, Sag FE, Katkat F, Tekin EE, Aydinli B, Vurgun VK. Predictors of Pacemaker-Induced Cardiomyopathy and Importance of Nutritional Status and Prognostic Nutritional Index. ACTA CARDIOLOGICA SINICA 2022; 38:151-158. [PMID: 35273436 DOI: 10.6515/acs.202203_38(2).20211117a] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Accepted: 11/17/2021] [Indexed: 11/23/2022]
Abstract
Background Long-term right ventricular (RV) pacing may cause progressive left ventricular systolic dysfunction, and malnutrition is related to adverse cardiovascular outcomes in patients with heart failure. We aimed to evaluate the relationship between immunonutritional status and the development of pacing-induced cardiomyopathy (PICMP). Methods This study included 434 patients who underwent permanent pacemaker (PPM) implantation and had preserved left ventricular ejection fraction (LVEF) of > 40%. At six months of follow-up, the patients with LVEF < 40% were defined as having PICMP. Baseline prognostic nutritional index (PNI) was calculated based on serum albumin and lymphocyte count. Results Overall, 16.5% of the our study patients developed PICMP. The PICMP group had more males (p = 0.013), lower baseline LVEF values (p = 0.014) and lower baseline PNI levels (p < 0.001). RV pacing ratios and paced QRS intervals were higher in the PICMP group (p < 0.001 for both), but the types of implanted pacemakers were similar for all patients (p = 0.709). According to regression analyses, baseline LVEF (p = 0.020), PNI (p < 0.001), C-reactive protein level (p = 0.012), RV pacing ratio (p < 0.001) and paced QRS interval (p = 0.001) were independent predictors of PICMP development. A cut-off PNI value ≤ 43.2 at the time of PPM implantation could predict PICMP development with a sensitivity of 85.5% and specificity of 86.7% (p < 0.001). Conclusions Identifying poor nutritional status using the PNI may be an important concept to predict PICMP development, and optimizing nutritional status might help to reduce adverse outcomes in these patients.
Collapse
Affiliation(s)
- Mehmet Balli
- Department of Cardiology, Mersin City Education and Research Hospital, Mersin
| | - Mustafa Çetin
- Department of Cardiology, SANKO University, Gaziantep
| | - Fatma Koksal
- Department of Cardiology, Mersin City Education and Research Hospital, Mersin
| | - Fazilet Erturk Sag
- Department of Cardiology, Mersin City Education and Research Hospital, Mersin
| | - Fahrettin Katkat
- Department of Cardiology, Bağcılar Education and Research Hospital, Istanbul
| | | | - Bahar Aydinli
- Department of Anesthesiology, Mersin City Education and Research Hospital, Mersin
| | | |
Collapse
|
27
|
Laksono S, Setianto B, Iqbal M, Prawara AS. Understanding Pacemaker-Induced Cardiomyopathy Incidence and Predictors in Patients with Right Ventricular Pacing: A Systematic Review. Int J Angiol 2022; 31:10-15. [PMID: 35221847 DOI: 10.1055/s-0041-1735206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
This study aimed to figure out the incidence and predictors of pacemaker-induced cardiomyopathy (PICM) in patients with right ventricular (RV) pacing. We systematically searched in PubMed on March 18, 2020, for English language abstract and full-article journals, using the following criteria: pacemaker induced cardiomyopathy AND right ventricular AND pacemaker AND patients AND human NOT implantable cardioverter defibrillator NOT ICD NOT animal. Four studies were included in this review after filtering 35 studies through year of publication and abstract selection. The average PICM incidence from 1,365 patients included from the four studies was 10.7 to 13.7%. One study stated that preimplantation left ventricular ejection fraction (LVEF) was the predictor for the development of PICM. Three studies mentioned that RV pacing burden was the predictor for the development of PICM. However, the percentage differ in three studies: ≥20, >40, and 60%. In addition, one of the studies also included interventricular dyssynchrony as another predictor. The incidence of PICM in patients with RV pacing ranged from 10.7 to 13.7%. Preimplantation LVEF, interventricular dyssynchrony, and burden of RV pacing are reported as the predictors for the development of PICM in patients with RV pacing.
Collapse
Affiliation(s)
- Sidhi Laksono
- Department of Cardiology and Vascular Medicine, RS Pusat Pertamina, South Jakarta, Indonesia.,Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Muhammadiyah Prof. Dr. Hamka, Tangerang, Indonesia
| | - Budhi Setianto
- Department of Cardiology and Vascular Medicine, National Heart Center of Harapan Kita, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Mohammad Iqbal
- Department of Cardiology and Vascular Medicine, Hasan Sadikin Hospital, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | - Ananta Siddhi Prawara
- Department of Emergency Medicine, Faculty of Medicine, Universitas Diponegoro, Semarang, Indonesia
| |
Collapse
|
28
|
Yang D, Zhu H, Ma M, Wang X, Pan X. A case of pacing-induced cardiomyopathy dramatically reversed by left bundle branch pacing in one week. HeartRhythm Case Rep 2021; 7:762-766. [PMID: 34820276 PMCID: PMC8602395 DOI: 10.1016/j.hrcr.2021.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Dandan Yang
- Department of Cardiology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Hong Zhu
- Department of Cardiology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Menghuai Ma
- Department of Cardiology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xiqiang Wang
- Department of Cardiovascular Medicine, First Affiliated Hospital of Xi'an Jiaotong University, 277 West Yanta Road, Xi'an, China
| | - Xiaohong Pan
- Department of Cardiology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| |
Collapse
|
29
|
Hemodynamic Effects of Permanent His Bundle Pacing Compared to Right Ventricular Pacing Assessed by Two-Dimensional Speckle-Tracking Echocardiography. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182111721. [PMID: 34770235 PMCID: PMC8583013 DOI: 10.3390/ijerph182111721] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Revised: 11/04/2021] [Accepted: 11/06/2021] [Indexed: 11/29/2022]
Abstract
We compared the effects of right ventricular (RVP; n = 26) and His bundle (HBP; n = 24) pacing in patients with atrioventricular conduction disorders and preserved LVEF. Postoperatively (1D), and after six months (6M), the patients underwent global longitudinal strain (GLS) and peak systolic dispersion (PSD) evaluation with 2D speckle-tracking echocardiography, assessment of left atrial volume index (LAVI) and QRS duration (QRSd), and sensing/pacing parameter testing. The RVP threshold was lower than the HBP threshold at 1D (0.65 ± 0.13 vs. 1.05 ± 0.20 V, p < 0.001), and then it remained stable, while the HBP threshold increased at 6M (1.05 ± 0.20 vs. 1.31 ± 0.30 V, p < 0.001). The RVP R-wave was higher than the HBP R-wave at 1D (11.52 ± 2.99 vs. 4.82 ± 1.41 mV, p < 0.001). The RVP R-wave also remained stable, while the HBP R-wave decreased at 6M (4.82 ± 1.41 vs. 4.50 ± 1.09 mV, p < 0.02). RVP QRSd was longer than HBP QRSd at 6M (145.0 ± 11.1 vs. 112.3 ± 9.3 ms, p < 0.001). The absolute value of RVP GLS decreased at 6M (16.32 ± 2.57 vs. 14.03 ± 3.78%, p < 0.001), and HBP GLS remained stable. Simultaneously, RVP PSD increased (72.53 ± 24.15 vs. 88.33 ± 30.51 ms, p < 0.001) and HBP PSD decreased (96.28 ± 33.99 vs. 84.95 ± 28.98 ms, p < 0.001) after 6 months. RVP LAVI increased (26.73 ± 5.7 vs. 28.40 ± 6.4 mL/m2, p < 0.05), while HBP LAVI decreased at 6M (30.03 ± 7.8 vs. 28.73 ± 8.7 mL/m2, p < 0.01). These results confirm that HBP does not disrupt ventricular synchrony and provides advantages over RVP.
Collapse
|
30
|
Abstract
Right ventricular (RV) pacing-induced cardiomyopathy (PICM) is typically defined as left ventricular systolic dysfunction resulting from electrical and mechanical dyssynchrony caused by RV pacing. RV PICM is common, occurring in 10-20% of individuals exposed to frequent RV pacing. Multiple risk factors for PICM have been identified, including male sex, wider native and paced QRS durations, and higher RV pacing percentage, but the ability to predict which individuals will develop PICM remains modest. Biventricular and conduction system pacing, which better preserve electrical and mechanical synchrony, typically prevent the development of PICM and reverse left ventricular systolic dysfunction after PICM has occurred.
Collapse
Affiliation(s)
- Shaan Khurshid
- Division of Cardiology and Cardiovascular Research Center, Massachusetts General Hospital, Yawkey 5B Heart Center, 55 Fruit Street, Boston, MA 02114, USA
| | - David S Frankel
- Cardiovascular Division, Perelman School of Medicine at the University of Pennsylvania, 3400 Spruce Street, 9 Founders Pavilion, Philadelphia, PA 19104, USA.
| |
Collapse
|
31
|
Abstract
Right ventricular pacing for bradycardia remains the mainstay of pacing therapy. Chronic right ventricular pacing may lead to pacing-induced cardiomyopathy. We focus on the anatomy of the conduction system and the clinical feasibility of pacing the His bundle and/or left bundle conduction system. We review the hemodynamics of conduction system pacing, the techniques to capture the conduction system and the electrocardiogram and pacing definitions of conduction system capture. Clinical studies of conduction system pacing in the setting of atrioventricular block and after AV junction ablation are reviewed and the evolving role of conduction system pacing is compared with biventricular pacing.
Collapse
|
32
|
Gavaghan C. Pacemaker Induced Cardiomyopathy: An Overview of Current Literature. Curr Cardiol Rev 2021; 18:e010921196020. [PMID: 34468302 DOI: 10.2174/2772432816666210901111616] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 05/24/2021] [Accepted: 06/27/2021] [Indexed: 11/22/2022] Open
Abstract
Pacemaker induced cardiomyopathy (PICM) is commonly defined as a reduction in left ventricular (LV) function in the setting of right ventricular (RV) pacing. This condition may be associated with the onset of clinical heart failure in those affected. Recent studies have focused on potential methods of identifying patients at risk of this condition, in addition to hypothesizing the most efficacious ways to manage these patients. Newer pacing options, such as His bundle pacing, may avoid the onset of PICM entirely.
Collapse
Affiliation(s)
- Callan Gavaghan
- Cardiology Department, Princess Alexandra Hospital, Brisbane, Australia
| |
Collapse
|
33
|
Ye Y, Wu S, Su L, Sheng X, Zhang J, Wang B, Sharma PS, Ellenbogen KA, Su Y, Chen X, Fu G, Huang W. Feasibility and Outcomes of Upgrading to Left Bundle Branch Pacing in Patients With Pacing-Induced Cardiomyopathy and Infranodal Atrioventricular Block. Front Cardiovasc Med 2021; 8:674452. [PMID: 34195236 PMCID: PMC8236829 DOI: 10.3389/fcvm.2021.674452] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 05/11/2021] [Indexed: 12/16/2022] Open
Abstract
His bundle pacing (HBP) can reverse left ventricular (LV) remodeling in patients with right ventricular (RV) pacing-induced cardimyopathy (PICM) but may be unable to correct infranodal atrioventricular block (AVB). Left bundle branch pacing (LBBP) results in rapid LV activation and may be able to reliably pace beyond the site of AVB. Our study was conducted to assess the feasibility, safety, and outcomes of permanent LBBP in infranodal AVB and PICM patients. Patients with infranodal AVB and PICM who underwent LBBP for cardiac resynchronization therapy (CRT) were included. Clinical evaluation and echocardiographic and electrocardiographic assessments were recorded at baseline and follow-up. Permanent LBBP upgrade was successful in 19 of 20 patients with a median follow-up duration of 12 months. QRS duration (QRSd) increased from 139.3 ± 28.0 ms at baseline to 176.2 ± 21.4 ms (P < 0.001) with right ventricular pacing (RVP) and was shortened to 120.9 ± 15.2 ms after LBBP (P < 0.001). The mean LBBP threshold was 0.7 ± 0.3 V at 0.4 ms at implant and remained stable during follow-up. The left ventricular ejection fraction (LVEF) increased from 36.3% ± 6.5% to 51.9% ± 13.0% (P < 0.001) with left ventricular end-systolic volume (LVESV) reduced from 180.1 ± 43.5 to 136.8 ± 36.7 ml (P < 0.001) during last follow-up. LBBP paced beyond the site of block, which results in a low pacing threshold with a high success rate in infranodal AVB patients. LBBP improved LV function with stable parameters over the 12 months, making it a reasonable alternative to cardiac resynchronization pacing via a coronary sinus lead in infranodal AVB and PICM patients.
Collapse
Affiliation(s)
- Yang Ye
- Department of Cardiology, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, China.,Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province, Hangzhou, China
| | - Shengjie Wu
- Department of Cardiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.,Key Lab of Cardiovascular Disease of Wenzhou, Wenzhou, China
| | - Lan Su
- Department of Cardiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.,Key Lab of Cardiovascular Disease of Wenzhou, Wenzhou, China
| | - Xia Sheng
- Department of Cardiology, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, China.,Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province, Hangzhou, China
| | - Jiefang Zhang
- Department of Cardiology, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, China.,Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province, Hangzhou, China
| | - Bei Wang
- Department of Cardiac Echocardiology, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Parikshit S Sharma
- Division of Cardiology, Rush University Medical Center, Chicago, IL, United States
| | | | - Yangang Su
- Department of Cardiology, Shanghai Institution of Cardiovascular Disease, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Xueying Chen
- Department of Cardiology, Shanghai Institution of Cardiovascular Disease, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Guosheng Fu
- Department of Cardiology, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, China.,Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province, Hangzhou, China
| | - Weijian Huang
- Department of Cardiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.,Key Lab of Cardiovascular Disease of Wenzhou, Wenzhou, China
| |
Collapse
|
34
|
Abstract
Background: The detrimental outcomes of right ventricular pacing on left ventricular electromechanical function ultimately result in heart failure, a phenomenon termed pacing-induced cardiomyopathy (PICM) in clinical research. This study aimed to validate prognostic factors that can be used to identify patients with higher susceptibility to progress to the stage of cardiomyopathy before pacemaker implantation. Methods: This observational analysis enrolled 256 patients between January 2013 and June 2016, 23 (8.98%) of whom progressed to PICM after 1 year of follow-up. A Cox proportional hazard model was used to analyze the prognostic factors associated with PICM. Dose-response analysis was used to evaluate the relationship between significant indicators in multifactor analysis and PICM. Results: The mean values of left ventricular ejection fraction before and after pacemaker implantation in 23 patients diagnosed with PICM were 62.3% and 42.7%, respectively. Univariate analysis showed that sex, atrio-ventricular block, paced QRS duration, and ventricular pacing percentage were significantly associated with PICM. In the multivariate analysis, male sex (hazard ratio: 1.20, 95% confidence interval [CI]: 1.09–1.33, P < 0.005), paced QRS duration (hazard ratio: 1.95 per 1 ms increase, 95% CI: 1.80–2.12, P < 0.001), and ventricular pacing percentage (hazard ratio: 1.65 per 1% increase, 95% CI: 1.51–1.79, P < 0.001) were independent prognostic factors associated with the development of PICM. The ventricular pacing percentage and paced QRS duration level defined by the dose-response analysis were positively associated with PICM (P < 0.05). Conclusions: Our findings indicated that paced QRS duration and ventricular pacing percentage were the most sensitive prognostic factors for PICM.
Collapse
|
35
|
Thourani VH, Edelman JJ, Holmes SD, Nguyen TC, Carroll J, Mack MJ, Kapadia S, Tang GHL, Kodali S, Kaneko T, Meduri CU, Forcillo J, Ferdinand FD, Fontana G, Suwalski P, Kiaii B, Balkhy H, Kempfert J, Cheung A, Borger MA, Reardon M, Leon MB, Popma JJ, Ad N. The International Society for Minimally Invasive Cardiothoracic Surgery Expert Consensus Statement on Transcatheter and Surgical Aortic Valve Replacement in Low- and Intermediate-Risk Patients: A Meta-Analysis of Randomized and Propensity-Matched Studies. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2021; 16:3-16. [PMID: 33491539 DOI: 10.1177/1556984520978316] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE There is an increasing amount of evidence supporting use of transcatheter aortic valve replacement (TAVR) for treatment of aortic stenosis in patients at low or intermediate risk for surgical aortic valve replacement (SAVR). TAVR is now approved for use in all patient cohorts. Despite this, there remains debate about the relative efficacy of TAVR compared with SAVR in lower-risk cohorts and various subgroups of patients. We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) and propensity-matched trials to guide a consensus among expert cardiologists and surgeons. METHODS Studies comparing TAVR and SAVR in low- and intermediate-risk patients were identified by a thorough search of the major databases. Mortality, stroke, and other perioperative outcomes were assessed at 30 days and 1 year. RESULTS Early mortality was lower in TAVR compared to SAVR in RCTs, but not propensity-matched studies in low-risk cohorts (0.66% vs 1.5%; odds ratio [OR] = 0.44, 95% confidence interval [CI] 0.20 to 0.98, I2 = 0%). No difference in mortality between TAVR and SAVR was identified in intermediate-risk patients at early or later time points. Incidence of perioperative stroke in 3 low-risk RCTs was significantly lower in TAVR (0.4%) than SAVR (1.4%; OR = 0.33, 95% CI 0.13 to 0.81, I2 = 0%). There was no difference in stroke for intermediate-risk patients between TAVR and SAVR. The expert panel of cardiologists and cardiac surgeons provided recommendations for TAVR and SAVR in various clinical scenarios. CONCLUSIONS In RCTs comparing TAVR and SAVR in low-risk patients, early mortality and stroke were lower in TAVR, but did not differ at 1 year. There was no difference in mortality and stroke in intermediate-risk patients. The Multidisciplinary Heart Team must consider individual patient characteristics and preferences when recommending TAVR or SAVR. The decision must consider the long-term management of each patient's aortic valve disease.
Collapse
Affiliation(s)
- Vinod H Thourani
- 165591 Department of Cardiovascular Surgery, Marcus Heart and Vascular Center, Piedmont Heart and Vascular Institute, Atlanta, GA, USA
| | - J James Edelman
- 2720 Department of Cardiac Surgery, Fiona Stanley Hospital, University of Western Australia, Perth, Australia
| | - Sari D Holmes
- 12264 Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Tom C Nguyen
- Division of Adult Cardiothoracic Surgery, University of California, San Francisco, CA, USA
| | - John Carroll
- 1878 Division of Cardiology, University of Colorado, Denver, CO, USA
| | - Michael J Mack
- 384526 Department of Cardiology, Baylor Health Care System, Heart Hospital Baylor Plano, Dallas, TX, USA
| | - Samir Kapadia
- 2569 Department of Cardiology, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Gilbert H L Tang
- 5944 Department of Cardiovascular Surgery, Mount Sinai Health System, New York, NY, USA
| | - Susheel Kodali
- 5798 Division of Cardiology, Columbia University Medical Center, New York, NY, USA
| | - Tsuyoshi Kaneko
- 1861 Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Christopher U Meduri
- 165591 Division of Cardiology, Marcus Heart and Vascular Center, Piedmont Heart Institute, Atlanta, GA, USA
| | - Jessica Forcillo
- 5622 Department of Cardiac Surgery, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Canada
| | - Francis D Ferdinand
- 6595 Department of Cardiothoracic Surgery, University of Pittsburgh School of Medicine & UPMC Hamot Heart and Vascular Institute, University of Pittsburgh Medical Center, PA, USA
| | - Gregory Fontana
- Cardiovascular Institute, Los Robles Hospital and Medical Center, Thousand Oaks, CA, USA
| | - Piotr Suwalski
- 359917 Department of Cardiac Surgery, Central Clinical Hospital of the Ministry of Interior and Administration, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Bob Kiaii
- 8789 Cardiothoracic Surgery, UC Davis Medical Center, Sacramento, CA, USA
| | - Husam Balkhy
- 12246 Section of Cardiac Surgery, University of Chicago Medicine, IL, USA
| | - Joerg Kempfert
- Department of Cardiac Surgery, German Heart Institute, Berlin, Germany
| | - Anson Cheung
- Department of Cardiac Surgery, The University of British Columbia, St. Paul's Hospital, Vancouver, Canada
| | | | - Michael Reardon
- Department of Cardiac Surgery, Methodist DeBakey Heart & Vascular Center, Houston, TX, USA
| | - Martin B Leon
- 5798 Division of Cardiology, Columbia University Medical Center, New York, NY, USA
| | - Jeffrey J Popma
- 1859 Department of Interventional Cardiology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Niv Ad
- 12264 Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, MD, USA.,Cardiovascular Surgery, Adventist White Oak Medical Center, Silver Spring, MD, USA
| |
Collapse
|
36
|
Chen AY, Upadhyay GA. Current Treatment Options in Cardiovascular Medicine Arrhythmia Section From the His Bundle to the Left Bundle: Clinical Applications of Conduction System Pacing. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2021. [DOI: 10.1007/s11936-020-00880-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
37
|
Fernandes GC, Knijnik L, Lopez J, Rivera M, Fernandes A, Lambrakos LK, Myerburg RJ, Mitrani RD, Goldberger JJ. Network meta-analysis of His bundle, biventricular, or right ventricular pacing as a primary strategy for advanced atrioventricular conduction disease with normal or mildly reduced ejection fraction. J Cardiovasc Electrophysiol 2020; 31:1482-1492. [PMID: 32275339 DOI: 10.1111/jce.14490] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Revised: 03/24/2020] [Accepted: 04/06/2020] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Although right ventricular pacing (RVP) may impair ventricular function, it is commonly used for advanced atrioventricular block (AVB) and normal or mildly reduced ejection fraction (EF). We aimed to compare His bundle pacing (HBP), biventricular pacing (BiVP), and RVP for advanced AVB in patients with normal or mildly reduced EF. METHODS AND RESULTS MEDLINE, Embase, Cochrane CENTRAL, ClinicalTrials.gov, Scopus, and Web of Science were searched. Outcomes were all-cause death, heart failure hospitalizations (HFH), EF, left ventricular volumes, 6-minute walk test, and QRS duration. HBP or BiVP was compared with RVP. Subsequently, network meta-analysis compared the three pacing options. Our protocol was registered in PROSPERO (CRD42018094132). Six studies compared BiVP and RVP (704 vs 614 patients) and four compared HBP and RVP (463 vs 568 patients). Follow-up was 6 months to 5 years. There was significantly lower mortality and HFH with HBP or BiVP as compared with RVP (odds ratio [OR], 0.66, [0.51-0.85], P = .002; OR, 0.61 [0.45-0.82], P < .001, respectively]. HBP or BiVP also showed significant increase in EF and decrease in QRS duration (mean difference [MD], 5.27 [3.86-6.69], P < .001; MD -42.2 [-51.2 to -33.3], P < .001, respectively). In network meta-analysis, HBP and BiVP were associated with significantly improved survival compared to RVP, with surface under the cumulative ranking curve (SUCRA) probability of 79.4%, 69.4%, and 1.2% for HBP, BiVP, and RVP, respectively. For HFH, SUCRA probability was 91.5%, 57.2%, and 1.3%, respectively. CONCLUSION HBP or BiVP were the superior strategies to reduce all-cause death and HFH for advanced AVB with normal or mildly reduced EF, with no significant difference between BiVP and HBP.
Collapse
Affiliation(s)
- Gilson C Fernandes
- Division of Cardiology, University of Miami Miller School of Medicine, Miami, Florida
| | - Leonardo Knijnik
- Department of Internal Medicine, University of Miami Miller School of Medicine, Miami, Florida
| | - Juan Lopez
- Department of Internal Medicine, University of Miami Miller School of Medicine, Miami, Florida
| | - Manuel Rivera
- Division of Cardiology, Washington University in Saint Louis, Saint Louis, Missouri
| | - Amanda Fernandes
- Department of Internal Medicine, University of Miami Miller School of Medicine, Miami, Florida
| | - Litsa K Lambrakos
- Division of Cardiology, University of Miami Miller School of Medicine, Miami, Florida
| | - Robert J Myerburg
- Division of Cardiology, University of Miami Miller School of Medicine, Miami, Florida
| | - Raul D Mitrani
- Division of Cardiology, University of Miami Miller School of Medicine, Miami, Florida
| | - Jeffrey J Goldberger
- Division of Cardiology, University of Miami Miller School of Medicine, Miami, Florida
| |
Collapse
|
38
|
Loboda D, Gibinski M, Zietek K, Wilczek J, Gardas R, Gladysz-Wanha S, Golba KS. Survival of patients with pacing-induced cardiomyopathy upgraded to CRT does not depend on defibrillation therapy. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2020; 43:471-478. [PMID: 32198771 DOI: 10.1111/pace.13906] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 02/15/2020] [Accepted: 03/15/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND Permanent right ventricular pacing (RVP) results in cardiac dyssynchrony that may lead to heart failure and may be an indication for the use of cardiac resynchronization therapy (CRT). The study aimed to evaluate predictors of outcomes in patients with pacing-induced cardiomyopathy (PICM) if upgraded to CRT. METHODS One hundred fifteen patients, 75.0 years old (IQR 67.0-80.0), were upgraded to CRT due to the decline in left ventricle ejection fraction (LVEF) caused by the long-term RVP. A retrospective analysis was performed using data from hospital and outpatient clinic records and survival data from the National Health System. RESULTS The prior percentage of RVP was 100.0% (IQR 97.0-100.0), with a QRS duration of 180.0 ms (IQR 160.0-200.0). LVEF at the time of the upgrade procedure was 27.0% (IQR 21.0-32.75). The mean follow-up was 980 ± 522 days. The primary endpoint, death from any cause, was met by 26 (22%) patients. Age > 82 years (HR 5.96; 95% CI 2.24-15.89; P = .0004) and pre-CRT implantation LVEF < 20% (HR 5.63; 95%CI 2.19-14.47; P = .0003), but neither the cardioverter-defibrillator (ICD) implantation (HR 1.00; 95%CI 0.45-2.22; P = 1.00), nor the presence of atrial fibrillation (HR 1.22; 95%CI 0.56-2.64; P = .62), were independently associated with all-cause mortality. CONCLUSION Advanced age and an extremely low LVEF, but neither the presence of atrial fibrillation nor implanting an additional high voltage lead, influence the all-cause mortality in patients after long-term RVP, when upgraded to CRT.
Collapse
Affiliation(s)
- Danuta Loboda
- Department of Electrocardiology and Heart Failure, Medical University of Silesia, Katowice, Poland
| | - Michal Gibinski
- Department of Electrocardiology and Heart Failure, Medical University of Silesia, Katowice, Poland
| | - Karolina Zietek
- Faculty of Medicine, Medical University of Silesia, Katowice, Poland
| | - Jacek Wilczek
- Department of Electrocardiology and Heart Failure, Medical University of Silesia, Katowice, Poland
| | - Rafal Gardas
- Department of Electrocardiology and Heart Failure, Medical University of Silesia, Katowice, Poland
| | - Sylwia Gladysz-Wanha
- Department of Electrocardiology and Heart Failure, Medical University of Silesia, Katowice, Poland
| | - Krzysztof S Golba
- Department of Electrocardiology and Heart Failure, Medical University of Silesia, Katowice, Poland
| |
Collapse
|
39
|
Dawkins JF, Hu YF, Valle J, Sanchez L, Zheng Y, Marbán E, Cingolani E. Antegrade Conduction Rescues Right Ventricular Pacing-Induced Cardiomyopathy in Complete Heart Block. J Am Coll Cardiol 2020; 73:1673-1687. [PMID: 30947921 DOI: 10.1016/j.jacc.2018.12.086] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2018] [Revised: 12/20/2018] [Accepted: 12/20/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND Right ventricular (RV) pacing-induced cardiomyopathy (PICM) occurs in ∼30% of patients with RV leads. This study evaluated the long-term effects of restoring antegrade conduction with a biological pacemaker in a porcine model of RV PICM. OBJECTIVES The goal of this study was to determine if antegrade biological pacing can attenuate RV PICM. METHODS In pigs with complete atrioventricular (AV) block, transcription factor T-box 18 (TBX18) was injected into the His bundle region in either of 2 experimental protocols: protocol A sought to prevent PICM, and protocol B sought to reverse PICM. In protocol A, we injected adenoviral vectors expressing TBX18 (or the reporter construct green fluorescent protein) after AV node ablation, and observed the animals for 8 weeks. In protocol B, PICM was established by using AV node ablation and 4 weeks of electronic RV pacing, at which point TBX18 was injected into the His bundle region. RESULTS In protocol A, TBX18 biological pacing led to superior chronotropic support (62.4 ± 3 beats/min vs. 50.4 ± 0.4 beats/min; p = 0.01), lower backup pacemaker utilization (45 ± 2.6% vs. 94.6 ± 1.4%; p = 0.001), and greater ejection fraction (58.5 ± 1.3% vs. 46.7 ± 2%; p = 0.001). In protocol B, full-blown RV PICM was evident 4 weeks after complete AV block in both groups; subsequent intervention led to higher mean heart rate (56 ± 2 beats/min vs. 50.1 ± 0.4 beats/min; p = 0.05), less backup pacemaker utilization (53 ± 8.2% vs. 95 ± 1.6%; p = 0.003), and a greater ejection fraction (61.7 ± 1.3% vs. 49 ± 1.6%; p = 0.0003) in TBX18-injected animals versus control animals. CONCLUSIONS In a preclinical model, pacemaker-induced cardiomyopathy can be prevented, and reversed, by restoring antegrade conduction with TBX18 biological pacing.
Collapse
Affiliation(s)
- James F Dawkins
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Yu-Feng Hu
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California; Division of Cardiology, Department of Internal Medicine, Taipei Veterans General Hospital and National Yang-Ming University, Taipei, Taiwan
| | - Jackelyn Valle
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Lizbeth Sanchez
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Yong Zheng
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Eduardo Marbán
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Eugenio Cingolani
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California.
| |
Collapse
|
40
|
Merchant FM, Mittal S. Pacing induced cardiomyopathy. J Cardiovasc Electrophysiol 2019; 31:286-292. [DOI: 10.1111/jce.14277] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 09/30/2019] [Accepted: 11/07/2019] [Indexed: 11/26/2022]
Affiliation(s)
| | - Suneet Mittal
- Cardiology DivisionValley Health System and The Snyder Center for Comprehensive Atrial Fibrillation Ridgewood New Jersey
| |
Collapse
|
41
|
Kaye G. The desire for physiological pacing: Are we there yet? J Cardiovasc Electrophysiol 2019; 30:3025-3038. [DOI: 10.1111/jce.14248] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 10/11/2019] [Accepted: 10/16/2019] [Indexed: 01/23/2023]
Affiliation(s)
- Gerry Kaye
- University of Queensland Medical School, Herston Brisbane Queensland Australia
| |
Collapse
|
42
|
Kaye G. The quest for physiological pacing-Does one size fit all? J Cardiovasc Electrophysiol 2019; 30:2977-2980. [PMID: 31626353 DOI: 10.1111/jce.14239] [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: 09/10/2019] [Accepted: 10/12/2019] [Indexed: 11/29/2022]
Abstract
Pacing is an established and ubiquitous treatment of bradycardias and some types of heart failure. The optimal pacing lead position which maximizes cardiac function and minimizes deterioration of ventricular function remains controversial. The desire to achieve a physiological pacing system that mimics cardiac function has led to the investigation of several potential pacing sites. This editorial provides an overview of past and current pacing lead position and summaries the current and future direction of physiological pacing.
Collapse
Affiliation(s)
- Gerry Kaye
- Division of Cardiology, University of Queensland Medical School, Brisbane, Queensland, Australia
| |
Collapse
|
43
|
Abstract
Abstract
Collapse
Affiliation(s)
- Faisal M Merchant
- Department of Cardiology, Emory University School of Medicine, Atlanta, GA, USA
| |
Collapse
|
44
|
Khurwolah MR, Yao J, Kong XQ. Adverse Consequences of Right Ventricular Apical Pacing and Novel Strategies to Optimize Left Ventricular Systolic and Diastolic Function. Curr Cardiol Rev 2019; 15:145-155. [PMID: 30499419 PMCID: PMC6520581 DOI: 10.2174/1573403x15666181129161839] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Revised: 11/20/2018] [Accepted: 11/22/2018] [Indexed: 11/25/2022] Open
Abstract
Several studies have focused on the deleterious consequences of Right Ventricular Apical (RVA) pacing on Left Ventricular (LV) function, mediated by pacing-induced ventricular dyssyn-chrony. Therapeutic strategies to reduce the detrimental consequences of RVA pacing have been pro-posed, that includes upgrading of RVA pacing to Cardiac Resynchronization Therapy (CRT), alterna-tive Right Ventricular (RV) pacing sites, minimal ventricular pacing strategies, as well as atrial-based pacing. In developing countries, single chamber RV pacing still constitutes a majority of cases of permanent pacing, and assessment of the optimal RV pacing site is of paramount importance. In chronically-paced patients, it is crucial to maintain as close and normal LV physiological function as possible, by minimizing ventricular dyssynchrony, reducing the chances for heart failure and other complications to develop. This review provides an analysis of the deleterious immediate and long-term consequences of RVA pacing, and the most recent available evidence regarding improvements in pacing options and strategies to optimize LV diastolic and systolic function. Furthermore, the place of advanced echocardiography in the identification of patients with pacing-induced LV dysfunction, the potential role of a new predictor of LV dysfunction in RV-paced subjects, and the long- term out-comes of patients with RV septal pacing will be explored
Collapse
Affiliation(s)
- Mohammad Reeaze Khurwolah
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, Jiangsu Province, China
| | - Jing Yao
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, Jiangsu Province, China
| | - Xiang-Qing Kong
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, Jiangsu Province, China
| |
Collapse
|