High Incidence of Dilated Cardiomyopathy After Right Ventricular Inlet Pacing in Patients With Congenital Complete Atrioventricular Block

Circ J. 2016 Apr 25;80(5):1251-8. doi: 10.1253/circj.CJ-15-1122. Epub 2016 Mar 24.


Background: Some patients with congenital complete atrioventricular block (CCAVB) develop dilated cardiomyopathy (DCM) after pacemaker implantation (PMI). We evaluated the relationship between pacing site and DCM incidence.

Methods and results: We retrospectively evaluated 38 patients with CCAVB; 8 (25%) of 32 patients who had PMI developed DCM/heart failure death (HFD) after PMI, although none of the 6 patients without PMI showed DCM/HFD. All DCM/HFD occurred within 50 months of PMI. Among the 32 patients with PMI, the DCM/HFD incidence was 55% (6/11) for right ventricular inlet (RVI), 18% (2/11) for RV apex (RVA), and 0% for left ventricle (LV) (P=0.013). At the endpoint, the LV ejection fraction and septal-to-posterior wall motion delay of patients with LV pacing were better than those for patients with other pacing sites. Among the 8 DCM/HFD patients, 2 in whom the pacing site was changed from RVI to LV apex or in whom therapy was upgraded to cardiac resynchronization remained alive with no heart failure symptoms, whereas the other 6 died of heart failure.

Conclusions: A total of 25% of the patients who underwent PMI because of CCAVB, but none in the non-PMI group, developed DCM/HFD. DCM/HFD incidence was higher in patients with RVI pacing. Ventricular dyssynchrony related to pacing site may be one cause of DCM in patients with CCAVB. (Circ J 2016; 80: 1251-1258).

MeSH terms

  • Atrioventricular Block / complications*
  • Atrioventricular Block / congenital
  • Atrioventricular Block / surgery
  • Cardiac Pacing, Artificial / adverse effects*
  • Cardiac Pacing, Artificial / methods
  • Cardiomyopathy, Dilated / etiology*
  • Cardiomyopathy, Dilated / mortality
  • Heart Failure / etiology
  • Heart Failure / mortality
  • Heart Ventricles / physiopathology
  • Humans
  • Incidence
  • Retrospective Studies