Major determinant of the occurrence of pacing-induced cardiomyopathy in complete atrioventricular block: a multicentre, retrospective analysis over a 15-year period in South Korea

Jun Hyung Kim, Ki-Woon Kang, Jung Yeon Chin, Tae-Seok Kim, Jae-Hyeong Park, Yu Jeong Choi, Jun Hyung Kim, Ki-Woon Kang, Jung Yeon Chin, Tae-Seok Kim, Jae-Hyeong Park, Yu Jeong Choi

Abstract

Objectives: The predictors of pacing-induced cardiomyopathy (PICM) for complete atrioventricular block (CAVB) have not yet been defined. The aim of this study was to investigate the major determinant of the occurrence of PICM.

Setting: This is a multicentre, retrospective analysis of CAVB from tertiary referral centres in Daejeon, South Korea.

Participants: A cohort of 900 consecutive patients with an implanted pacemaker was collected from December 2001 to August 2015. Of these, a total of 130 patients with CAVB with pacing-dependent rhythm who underwent ECG and echocardiogram before and after implantation were analysed for the occurrence of PICM.

Outcome measures: Cox proportional hazards models evaluated the determinant of PICM by ECG, device parameters and echocardiogram over a mean of 4.5 years.

Results: PICM was observed in 16.1% (n=21) of all patients with CAVB (age, 64±11 years; male, 36.2%). The preimplant left ventricular (LV) ejection fraction (66%±9% vs 66%±8%) and non-apical pacing (40.4% vs 33.3%) were similar; however, the native QRS duration (124±34 ms vs 149±32 ms) and the paced QRS duration (pQRSd) (139±29 ms vs 167±28 ms) were significantly different between the two groups. The postimplant LV ejection fraction (61%±7% vs 31%±8%) was also significantly different at the end of follow-up. A pQRSd significantly correlated with PICM (HR 1.05, 95% CI 1.02 to 1.09, P=0.001). A pQRSd with a cut-off value of above 140 ms had a sensitivity of 95% while a pQRSd with a cut-off value of above 167 ms had a specificity of 90% for PICM.

Conclusion: In patients with CAVB with pacing-dependent rhythm, regardless of the pacing site, the pQRSd is a major determinant of the occurrence of PICM.

Keywords: cardiomyopathy; complete AV block; pacemaker.

Conflict of interest statement

Competing interests: None declared.

© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Figures

Figure 1
Figure 1
Receiver operating characteristic curve analysis showing the pQRSd had correlated with the occurrence of pacing-induced cardiomyopathy and two rectangular black marks showing the best sensitivity (pQRSd 140 ms) and specificity (pQRSd 167 ms) with statistical significance. pQRSd, paced QRS duration.
Figure 2
Figure 2
Kaplan-Meier curve analysis showing free-from-PICM survival with a pQRSd (cut-off value of 140 ms and 167 ms). PICM, pacing-induced cardiomyopathy; pQRSd, paced QRS duration.

References

    1. Akerström F, Pachón M, Puchol A, et al. . Chronic right ventricular apical pacing: adverse effects and current therapeutic strategies to minimize them. Int J Cardiol 2014;173:351–60. 10.1016/j.ijcard.2014.03.079
    1. Wilkoff BL, Cook JR, Epstein AE, et al. . Dual-chamber pacing or ventricular backup pacing in patients with an implantable defibrillator: the Dual Chamber and VVI Implantable Defibrillator (DAVID) Trial. JAMA 2002;288:3115–23.
    1. Shimony A, Eisenberg MJ, Filion KB, et al. . Beneficial effects of right ventricular non-apical vs. apical pacing: a systematic review and meta-analysis of randomized-controlled trials. Europace 2012;14:81–91. 10.1093/europace/eur240
    1. Dreger H, Maethner K, Bondke H, et al. . Pacing-induced cardiomyopathy in patients with right ventricular stimulation for >15 years. Europace 2012;14:238–42. 10.1093/europace/eur258
    1. Strauss DG, Selvester RH, Wagner GS. Defining left bundle branch block in the era of cardiac resynchronization therapy. Am J Cardiol 2011;107:927–34. 10.1016/j.amjcard.2010.11.010
    1. Ghani A, Delnoy PP, Ottervanger JP, et al. . Assessment of left ventricular dyssynchrony in pacing-induced left bundle branch block compared with intrinsic left bundle branch block. Europace 2011;13:1504–7. 10.1093/europace/eur117
    1. Khurshid S, Epstein AE, Verdino RJ, et al. . Incidence and predictors of right ventricular pacing-induced cardiomyopathy. Heart Rhythm 2014;11:1619–25. 10.1016/j.hrthm.2014.05.040
    1. Kaye GC, Linker NJ, Marwick TH, et al. . Effect of right ventricular pacing lead site on left ventricular function in patients with high-grade atrioventricular block: results of the Protect-Pace study. Eur Heart J 2015;36:856–62. 10.1093/eurheartj/ehu304
    1. Udo EO, van Hemel NM, Zuithoff NP, et al. . Risk of heart failure- and cardiac death gradually increases with more right ventricular pacing. Int J Cardiol 2015;185:95–100. 10.1016/j.ijcard.2015.03.053
    1. Fihn SD, Gardin JM, Abrams J, et al. . ACCF/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the diagnosis and management of patients with stable ischemic heart disease: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, and the American College of Physicians, American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. J Am Coll Cardiol 2012;2012:e44–e164.
    1. Surawicz B, Childers R, Deal BJ, et al. . AHA/ACCF/HRS recommendations for the standardization and interpretation of the electrocardiogram: part III: intraventricular conduction disturbances: a scientific statement from the American Heart Association Electrocardiography and Arrhythmias Committee, Council on Clinical Cardiology; the American College of Cardiology Foundation; and the Heart Rhythm Society: endorsed by the International Society for Computerized Electrocardiology. Circulation 2009;119:e235–e240. 10.1161/CIRCULATIONAHA.108.191095
    1. McKee PA, Castelli WP, McNamara PM, et al. . The natural history of congestive heart failure: the Framingham study. N Engl J Med 1971;285:1441–6. 10.1056/NEJM197112232852601
    1. Khurshid S, Liang JJ, Owens A, et al. . Longer Paced QRS Duration is Associated With Increased Prevalence of Right Ventricular Pacing-Induced Cardiomyopathy. J Cardiovasc Electrophysiol 2016;27:1174–9. 10.1111/jce.13045
    1. Kiehl EL, Makki T, Kumar R, et al. . Incidence and predictors of right ventricular pacing-induced cardiomyopathy in patients with complete atrioventricular block and preserved left ventricular systolic function. Heart Rhythm 2016;13:2272–8. 10.1016/j.hrthm.2016.09.027
    1. Stambler BS, Ellenbogen K, Zhang X, et al. . Right ventricular outflow versus apical pacing in pacemaker patients with congestive heart failure and atrial fibrillation. J Cardiovasc Electrophysiol 2003;14:1180–6. 10.1046/j.1540-8167.2003.03216.x
    1. Chan NY, Yuen HC, Choy CC, et al. . Left ventricular volumes and systolic function after long-term right ventricular pacing may be predicted by paced QRS duration, but not pacing site. Heart Lung Circ 2014;23:43–8. 10.1016/j.hlc.2013.04.122
    1. Chen S, Yin Y, Lan X, et al. . Paced QRS duration as a predictor for clinical heart failure events during right ventricular apical pacing in patients with idiopathic complete atrioventricular block: results from an observational cohort study (PREDICT-HF). Eur J Heart Fail 2013;15:352–9. 10.1093/eurjhf/hfs199
    1. Pan W, Su Y, Gong X, et al. . Value of the paced QRS duration. J Card Fail 2009;15:347–52. 10.1016/j.cardfail.2008.11.008
    1. Pap R, Fürge P, Bencsik G, et al. . Native QRS complex duration predicts paced QRS width in patients with normal left ventricular function and right ventricular pacing for atrioventricular block. J Electrocardiol 2007;40:360–4. 10.1016/j.jelectrocard.2006.10.060
    1. Pan W, Su Y, Sun A, et al. . Native and paced QRS duration in right ventricular apex paced patients. J Card Fail 2010;16:239–43. 10.1016/j.cardfail.2009.10.021
    1. Miyoshi F, Kobayashi Y, Itou H, et al. . Prolonged paced QRS duration as a predictor for congestive heart failure in patients with right ventricular apical pacing. Pacing Clin Electrophysiol 2005;28:1182–8. 10.1111/j.1540-8159.2005.50181.x
    1. Fonseca C, Morais H, Mota T, et al. . The diagnosis of heart failure in primary care: value of symptoms and signs. Eur J Heart Fail 2004;6:795–800. 10.1016/j.ejheart.2004.08.002
    1. Thosani AJ, Liu E, Shaw G, et al. . Rapid reversal of right ventricular pacing-induced cardiomyopathy by His bundle pacing. HeartRhythm Case Rep 2017;3:189–91. 10.1016/j.hrcr.2017.01.004
    1. Ajijola OA, Upadhyay GA, Macias C, et al. . Permanent His-bundle pacing for cardiac resynchronization therapy: Initial feasibility study in lieu of left ventricular lead. Heart Rhythm 2017;14:1353–61. 10.1016/j.hrthm.2017.04.003
    1. Shah KS, Xu H, Matsouaka RA, et al. . Heart Failure With Preserved, Borderline, and Reduced Ejection Fraction: 5-Year Outcomes. J Am Coll Cardiol 2017:2476–86. 10.1016/j.jacc.2017.08.074

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