Predictors of Right ventricular Pacing induced Left Ventricular dysfunction in Pacemaker Recipients with Preserved Ejection Fraction

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Mohamed Abdelmohsen Sayed ◽  
Emad Effat ◽  
Haitham Badran ◽  
Said Khaled
Keyword(s):  
Ejection Fraction ◽  
Right Ventricular ◽  
Left Ventricular Dysfunction ◽  
Ventricular Dysfunction ◽  
Pacemaker Implantation ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Pacing ◽  
Ventricular Ejection Fraction ◽  
Right Ventricular Pacing

Abstract Background Pacemaker (PM) has been an effective treatment in the management of patients with brady-arrhythmias. Chronic RV pacing may cause electrical and mechanical dyssynchrony which lead finally to reduced left ventricular ejection fraction (LVEF). This deterioration of LVEF has been defined as pacemaker induced cardiomyopathy (PICM). The incidence of PICM was described by many studies and ranged between 10% to 26%. The predictors for PICM have not been well studied. These studies were limited by variation in follow-up period and definition of PICM. Objective to study the incidence and predictors of PICM in patients who underwent pacemaker implantation in Ain shams University hospital. Patients and Methods This retrospective study included 160 patients who underwent single or dual chamber pacemaker implantation in Ain shams university hospital between 2010 and 2017 with the mean period 4.7±2.0 years. Implantable cardioverter defibrillator (ICD) and cardiac resynchronization therapy (CRT) patients were excluded. Individuals who had baseline transthoracic echocardiography (TTE) with normal LVEF ≥ 50% before implantation were included. Results This study included 160 patients who had single or dual chamber pacemaker implantation between 2010 and 2017. 45% were males and 55% were females, mean age was 55.5 years. It showed that the incidence of PICM is 7.5%. Wider native QRS durations, particularly >140 ms (p < 0.001), wider pQRS duration >150 ms (p < 0.001), Low normal ejection fraction <56 % preimplantation (p = 0.023) and increased LVEDD>53 mm and LVESD>38 mm (p < 0.001) are predictors for the development of PICM. Female gender was independent predictor for PICM (p = 0.058). There was no association between burden of right ventricular pacing (p = 0.782) or pacing site (p = 0.876) with the risk of development of left ventricular dysfunction. Conclusion The incidence of right ventricular pacing-induced left ventricular dysfunction is not uncommon, with an observed incidence of 7.5% in the current study. Wider native and paced QRS durations, Low normal ejection fraction (< 56 %) pre-implantation and increased LVEDD /LVESD post implantation are the most important predictors for the development of PICM. List of abbreviations PM= pacemaker, RV= Right ventricle, PICM = pacemaker induced cardiomyopathy, TTE= transthoracic echocardiography, DM= Diabetes Mellitus, HTN= Hypertension, BMI= Body Mass index, pQRSd= Paced QRS duration, SWMA= segmental wall motion abnormality, AF= Atrial fibrillation, SSS= Sick sinus syndrome, CHB= Complete heart block, AVB= Atrioventricular block, LVEF = left ventricular ejection fraction, LVEDD= Left ventricular end diastolic diameter, LVESD= Left ventricular end systolic diameter, ms= milli second.

scholarly journals The pacemaker ventricular lead position and outcomes in patients upgrading to crt

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
BV Silva ◽  
J Brito ◽  
T Rodrigues ◽  
P Silverio Antonio ◽  
S Couto Pereira ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Right Ventricular ◽  
Pacemaker Implantation ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Pacing ◽  
Ventricular Ejection Fraction ◽  
Right Ventricular Pacing ◽  
Ventricular Lead

Abstract Funding Acknowledgements Type of funding sources: None. Introduction   Adverse hemodynamic effects of right ventricular pacing are known, and the optimal right ventricular lead position is still being a matter of debate. According to the guidelines, upgrade to cardiac resynchronization therapy (CRT) is recommended in patients with indication for pacemaker and left ventricular ejection fraction less than 50% or who need more than 40% of ventricular pacing. Purpose   To compare clinical outcomes and ejection fraction in patients with previous pacemaker (apical versus septal right ventricular pacing) who are upgrated to CRT.  Methods   Single-center retrospective study of 94 consecutive patients who had previous pacemaker and upgraded to CRT over a 4-year period. Of these patients, 64 had previous apical lead pacemaker and 30 had previous septal lead pacemaker. Data on comorbidities, New York Heart Association (NYHA), left ventricular ejection fraction and hospitalizations due to heart failure were collected. The results were obtained using Chi-square, Mann-Whitney and t-test. Results Patients with septal pacemaker had significantly more diabetes (p = 0.04) and chronic obstructive pulmonary disease (p = 0.01), tended to be more symptomatic (p = 0.198) and had more days of hospitalization before and after pacemaker implantation (12 ± 3 versus 7 ± 2 days and 8 ± 4 versus 3 ± 1 days, respectively), mostly due heart failure decompensation.  Although there were no significant differences in the initial ejection fraction in patients with apical or septal pacemaker implantation (31.2 ± 1.2% and 29.1 ± 1.5%, respectively, p = 0.323), the time to upgrade to CRT was significantly shorter in patients with septal pacemaker implantation (1999 ± 227 days versus 3005 ± 279 days, p = 0.005).  After upgrading to CRT, patients with apical lead had a significant increase in ejection fraction (8.2%, p = 0.011), while patients with septal lead had a non-significant improvement of ejection fraction (4.5%, p = 0.448). In both, apical and septal lead patients, there was a significant improvement in NYHA class after upgrade to CRT (p = 0.03 and p = 0.02, respectively). Conclusion   Although patients with septal lead had more comorbidities and hospitalizations due to heart failure, they do not benefit from the upgrade to CRT, unlike what happens in patients with apical lead. These findings can be explained by the fact that the septal lead minimizes ventricular desynchrony induced by right ventricular pacing.

scholarly journals Understanding Pacing-Induced Cardiomyopathy: a mini review

2021 ◽  
Vol 5 (2) ◽  
Author(s):  
Sidhi Laksono Purwowiyoto ◽  
Reynaldo Halomoan Siregar ◽  
Steven Philip Surya
Keyword(s):  
Cardiac Function ◽  
Right Ventricular ◽  
Sinus Node ◽  
Pacemaker Implantation ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Preventive Strategy ◽  
Ventricular Pacing ◽  
Ventricular Ejection Fraction ◽  
Right Ventricular Pacing

Patients with total atrioventricular block or sinus node dysfunction will need pacemaker implantation to improve the physiologic function of the heart.  It is known that chronic pacing such as right ventricular pacing could deteriorate the cardiac function (decreased left ventricular ejection fraction) due to dyssynchrony. This condition is knows as pacing-induced cardiomyopathy (PICM). The incidence of PICM could reach 19.5% during 3 years follow-up. The right ventricle is one of the locations for implantation. Chronic right ventricular pacing may cause interventricular dyssynchrony and disrupt the contraction mechanism in the heart. These will lead to cardiac remodeling and eventually impair the left ventricular function. Therapy is needed in patients with PICM to improve the symptoms and maintain the cardiac function. This article will further highlight the definition, mechanism, risk factor, treatment and preventive strategy for patients with PICM.

scholarly journals Outcomes of novel pacing technologies with right ventricular pacing as a primary strategy for patient undergoing transvenous permanent pacing regardless of pacing indication

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
A Abdin ◽  
S Aktaa ◽  
D Vukadinovic ◽  
E Arbelo ◽  
M Boehm ◽  
...  
Keyword(s):  
Left Ventricular Ejection Fraction ◽  
Ejection Fraction ◽  
Right Ventricular ◽  
De Novo ◽  
Left Ventricular ◽  
Ventricular Ejection ◽  
Left Ventricular Ejection ◽  
Ventricular Pacing ◽  
Ventricular Ejection Fraction ◽  
Right Ventricular Pacing

Abstract Background Right ventricular pacing (RVP) may cause electrical and mechanical desynchrony leading to impaired left ventricular ejection fraction (LVEF). We investigated the outcomes of RVP with His bundle pacing (HBP) and left bundle branch pacing (LBBP) for patients requiring a de novo permeant pacemaker (PPM) irrespective of baseline pacing indication. Methods and results Systematic review of randomized clinical trials and observational studies comparing HBP or LBP with RVP for de novo PPM implantation between 01 January 2013 and 17 November 2020 using MEDLINE and Embase. Two independent reviewers extracted the data and assessed the risk of bias of included studies. Random and fixed effects meta-analyses of the effect of pacing technology on study outcomes (all-cause mortality, heart failure hospitalization (HFH), left ventricular ejection fraction, QRS duration, lead revision, atrial fibrillation and procedure and pacing metrics) were performed. Overall, 7 studies were included. HBP compared with RVP was associated with decreased mortality (risk ratio [RR] 0.76, 95% CI 0.59 to 0.98), preservation of LVEF (mean difference [MD] 1.2, 95% CI −1.37 to 3.8 vs. −5.22, 95% CI: −6.94 to −3.51), increased procedure duration (MD 15.17 min, 95% CI: 11.27 to 19.07) and more lead revisions (RR 6.30, 95% CI: 2.31 to 17.19). LBBP compared with RVP was associated with shorter paced QRS durations (MD 5.6 ms, 95% CI −6.4 to 17.6) vs. (51.0 ms, 95% CI 39.2 to 62.9) and increased procedure durations (MD 37.78 min, 95% CI: 20.04 to 55.51). Conclusion Of the limited studies published, this meta-analysis found that HBP and LBBP were superior to RVP in maintaining physiological ventricular activation as an initial pacing strategy. Well conducted comparative studies are required to understand the impact of such novel pacing strategies on clinical outcomes. FUNDunding Acknowledgement Type of funding sources: None.

scholarly journals Forward Left Ventricular Ejection Fraction as a Predictor of Postoperative Left Ventricular Dysfunction in Patients with Degenerative Mitral Regurgitation

2021 ◽  
Vol 10 (14) ◽  
pp. 3013
Author(s):  
Juyoun Kim ◽  
Jae-Sik Nam ◽  
Youngdo Kim ◽  
Ji-Hyun Chin ◽  
In-Cheol Choi
Keyword(s):  
Left Ventricular Ejection Fraction ◽  
Mitral Regurgitation ◽  
Ejection Fraction ◽  
Left Ventricular Dysfunction ◽  
Predictive Value ◽  
Ventricular Dysfunction ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Normal Lvef

Background: Left ventricular dysfunction (LVD) can occur immediately after mitral valve repair (MVr) for degenerative mitral regurgitation (DMR) in some patients with normal preoperative left ventricular ejection fraction (LVEF). This study investigated whether forward LVEF, calculated as left ventricular outflow tract stroke volume divided by left ventricular end-diastolic volume, could predict LVD immediately after MVr in patients with DMR and normal LVEF. Methods: Echocardiographic and clinical data were retrospectively evaluated in 234 patients with DMR ≥ moderate and preoperative LVEF ≥ 60%. LVD and non-LVD were defined as LVEF < 50% and ≥50%, respectively, as measured by echocardiography after MVr and before discharge. Results: Of the 234 patients, 52 (22.2%) developed LVD at median three days (interquartile range: 3–4 days). Preoperative forward LVEF in the LVD and non-LVD groups were 24.0% (18.9–29.5%) and 33.2% (26.4–39.4%), respectively (p < 0.001). Receiver operating characteristic (ROC) analyses showed that forward LVEF was predictive of LVD, with an area under the ROC curve of 0.79 (95% confidence interval: 0.73–0.86), and an optimal cut-off was 31.8% (sensitivity: 88.5%, specificity: 58.2%, positive predictive value: 37.7%, and negative predictive value: 94.6%). Preoperative forward LVEF significantly correlated with preoperative mitral regurgitant volume (correlation coefficient [CC] = −0.86, p < 0.001) and regurgitant fraction (CC = −0.98, p < 0.001), but not with preoperative LVEF (CC = 0.112, p = 0.088). Conclusion: Preoperative forward LVEF could be useful in predicting postoperative LVD immediately after MVr in patients with DMR and normal LVEF, with an optimal cut-off of 31.8%.

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