Risk factors of pacing dependence and cardiac dysfunction in patients with permanent pacemaker implantation

Ziqing Yu; Yixiu Liang; Zilong Xiao; Yucheng Wang; Pei Bao; Chunyu Zhang; Enyong Su; Minghui Li; Xueying Chen; Shengmei Qin; Ruizhen Chen; Yangang Su; Junbo Ge

doi:10.1002/ehf2.13918

Risk factors of pacing dependence and cardiac dysfunction in patients with permanent pacemaker implantation

ESC Heart Fail. 2022 Aug;9(4):2325-2335. doi: 10.1002/ehf2.13918. Epub 2022 Apr 26.

Authors

Ziqing Yu^{1

2}, Yixiu Liang^{1

2}, Zilong Xiao¹, Yucheng Wang¹, Pei Bao¹, Chunyu Zhang^{1

2}, Enyong Su¹, Minghui Li^{1

2}, Xueying Chen^{1

2}, Shengmei Qin^{1

2}, Ruizhen Chen^{1

3}, Yangang Su^{1

2}, Junbo Ge^{1

2}

Affiliations

¹ Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China.
² National Clinical Research Center for Interventional Medicine, Shanghai, China.
³ Department of Cardiovascular Diseases, Key Laboratory of Viral Heart Diseases, Ministry of Public Health, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China.

Abstract

Aims: Right ventricular pacing (RVP) dependence could impair left ventricular ejection fraction (LVEF). This study aimed to illuminate the relationship between RVP proportion and LVEF, as well as disclosing independent predictors of RVP dependence.

Methods and results: Patients indicated for permanent pacemaker implantation were included (2016-2020). The ventricular pacing lead was placed in right ventricular apex or septum. Pacing mode programming followed universal standard. Electrocardiographic, echocardiographic, and serological parameters were collected. RVP dependence was defined according to its influence on LVEF. This study was of case-control design. Included patients were matched by potentially confounding factors through propensity score matching. A total of 1183 patients were included, and the mean duration of follow-up was 24 months. Percentage of RVP < 80% hardly influenced LVEF; however, LVEF tended to decrease with higher RVP proportion. High degree/complete atrioventricular block (AVB) [odds ratio (OR) = 5.71, 95% confidence interval (CI): 3.66-8.85], atrial fibrillation (AF) (OR = 2.04, 95% CI: 1.47-2.82), percutaneous coronary intervention (PCI) (OR = 2.89, 95% CI: 1.24-6.76), maximum heart rate (HR_max ) < 110 b.p.m. (OR = 2.74, 95% CI: 1.58-4.76), QRS duration > 120 ms (OR = 2.46, 95% CI: 1.42-4.27), QTc interval > 470 ms (OR = 2.01, 95% CI: 1.33-3.05), and pulmonary artery systolic pressure (PASP) > 40 mmHg (OR = 1.93, 95% CI: 1.46-2.56) were proved to predict RVP dependence.

Conclusions: High RVP percentage (>80%) indicating RVP dependence significantly correlates with poor prognosis of cardiac function. High degree/complete AVB, AF, ischaemic aetiology, PCI history, HR_max < 110 b.p.m., QRS duration > 120 ms, QTc interval > 470 ms, and PASP > 40 mmHg were verified as independent risk factors of RVP dependence.

Keywords: Cardiac dysfunction; Pacemaker; Pacing dependence; Right ventricular pacing.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Atrial Fibrillation* / etiology
Atrioventricular Block* / epidemiology
Atrioventricular Block* / etiology
Atrioventricular Block* / therapy
Cardiac Pacing, Artificial / adverse effects
Cardiac Pacing, Artificial / methods
Humans
Pacemaker, Artificial* / adverse effects
Percutaneous Coronary Intervention*
Risk Factors
Stroke Volume / physiology
Ventricular Function, Left / physiology