Pacemaker Induced Cardiomyopathy: An Overview of Current Literature

2021 ◽  
Vol 17 ◽  
Author(s):  
Callan Gavaghan
Keyword(s):  
Heart Failure ◽  
At Risk ◽  
Right Ventricular ◽  
Current Literature ◽  
Left Ventricular ◽  
Lv Function ◽  
Patients At Risk ◽  
Rv Pacing ◽  
Clinical Heart Failure ◽  
Potential Methods

: 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.

Adverse effects of atrioventricular synchronous right ventricular pacing on left ventricular sympathetic activity, efficiency, and hemodynamic status

2006 ◽  
Vol 291 (5) ◽  
pp. H2377-H2379 ◽  
Author(s):  
Abdul Al-Hesayen ◽  
John D. Parker
Keyword(s):  
Heart Failure ◽  
Right Ventricular ◽  
Sympathetic Activity ◽  
Left Ventricular ◽  
Right Atrial ◽  
Lv Function ◽  
Atrial Pacing ◽  
Ventricular Pacing ◽  
Rv Pacing ◽  
Norepinephrine Spillover

Right ventricular (RV) pacing is now recognized to play a role in the development of heart failure in patients with and without underlying left ventricular (LV) dysfunction. We used the cardiac norepinephrine spillover method to test the hypothesis that RV pacing is associated with cardiac sympathetic activation. We studied 8 patients with normal LV function using temporary right atrial and ventricular pacing wires. All measurements were carried out during a fixed atrial pacing rate. The radiotracer norepinephrine spillover technique was employed to measure total body and cardiac sympathetic activity while changes in LV performance were evaluated with a high-fidelity manometer catheter. Atrioventricular synchronous RV pacing, compared with atrial pacing alone, was associated with a 65% increase in cardiac norepinephrine spillover, an increase in LV end-diastolic pressure, and a reduction in myocardial efficiency. These responses may play a role in the development of heart failure and poor outcomes that are associated with chronic RV pacing.

scholarly journals Detrimental immediate and long-term clinical effects of right ventricular pacing in patients with myocardial fibrosis

2021 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
C Saunderson ◽  
MF Paton ◽  
LAE Brown ◽  
J Gierula ◽  
PG Chew ◽  
...  
Keyword(s):  
Heart Failure ◽  
Right Ventricular ◽  
Pacemaker Implantation ◽  
Mechanical Dyssynchrony ◽  
Volume Index ◽  
Lv Function ◽  
P Value ◽  
Rv Pacing ◽  
Dyssynchrony Index

Abstract Funding Acknowledgements Type of funding sources: None. Background Long-term right ventricular (RV) pacing leads to heart failure or a decline in left ventricular (LV) function in up to a fifth of patients. Objectives We aimed to establish whether patients with focal fibrosis detected on late gadolinium enhancement cardiovascular magnetic resonance (CMR) have deterioration in LV function after RV pacing. Methods We recruited 110 patients (84 in final analysis) into two observational CMR studies. Patients (n = 34) with a dual chamber device and preserved atrioventricular (AV) conduction underwent CMR in two asynchronous pacing modes (AOO & DOO) to compare intrinsic conduction with RV pacing. Patients (n = 50) with high-grade AV block underwent CMR before and 6 months after pacemaker implantation to investigate the long-term effects of RV pacing. Results: The three key findings were 1) Initiation of RV pacing in patients with fibrosis, compared to those without, was associated with greater immediate changes in both LV end-systolic volume index (LVESVi) (5.3 ± 3.5 vs 2.1 ± 2.4 mL/m2; p < 0.01) and LV ejection fraction (LVEF) (-5.7 ± 3.4% vs -3.2 ± 2.6%; p = 0.02); 2) Long-term RV pacing in patients with fibrosis, compared to those without, was associated with greater changes in LVESVi (8.0 ± 10.4 vs -0.6 ± 7.3 mL/m2; p = 0.008) and LVEF (-12.3 ± 7.9 vs -6.7 ± 6.2%; p = 0.012); 3) Patients with fibrosis did not experience an improvement in quality of life, biomarkers or functional class after pacemaker implantation. Conclusions Fibrosis detected on CMR is associated with immediate and long-term deterioration in LV function following RV pacing and could be used to identify those at risk of heart failure prior to pacemaker implantation. Characteristics before and after pacing Study 1 No fibrosis (n = 16) Fibrosis (n = 18) AOO DOO p-value AOO DOO p-value LVEDVi - mL/m² 66 ± 13 66 ± 12 0.67 78 ± 14 79 ± 13 0.34 LVESVi - mL/m² 30 ± 10 32 ± 9 0.003 38 ± 11 43 ± 12 <0.001 LVEF - % 56 ± 6 53 ± 5 <0.001 52 ± 8 47 ± 9 <0.001 Mechanical Dyssynchrony index - ms 61 ± 17 71 ± 25 0.07 81 ± 18 89 ± 21 0.04 Study 2 No fibrosis (n = 19) Fibrosis (n = 31) Pre-PPM Post-PPM p-value Pre-PPM Post-PPM p-value LVEDVi -mL/m² 88 ± 21 73 ± 14 <0.001 90 ± 18 83 ± 21 0.007 LVESVi -mL/m² 35 ± 9 34 ± 9 0.71 41 ± 14 49 ± 21 0.001 LVEF - % 60 ± 5 54 ± 7 <0.001 56 ± 8 43 ± 12 <0.001 Mechanical Dyssynchrony index - ms 70 ± 29 81 ± 22 0.15 84 ± 30 98 ± 31 0.03 Abstract Figure. Mechanism for heart failure after pacing

scholarly journals Using deep learning algorithms to simultaneously identify right and left ventricular dysfunction from the electrocardiogram.

2021 ◽  
Author(s):  
Akhil Vaid ◽  
Kipp W Johnson ◽  
Marcus A Badgeley ◽  
Sulaiman Somani ◽  
Mesude Bicak ◽  
...  
Keyword(s):  
Heart Failure ◽  
Deep Learning ◽  
Right Ventricular ◽  
Systolic Dysfunction ◽  
External Validation ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Lv Function ◽  
Ventricular Ejection Fraction ◽  
Left And Right

Background Rapid evaluation of left and right ventricular function using deep learning (DL) on electrocardiograms (ECG) can assist diagnostic workflow. However, DL tools to estimate right ventricular (RV) function do not exist, while ones to estimate left ventricular (LV) function are restricted to quantification of very low LV function only. Objectives This study sought to develop deep learning models capable of comprehensively quantifying left and right ventricular dysfunction from ECG data in a large, diverse population. Methods A multi-center study was conducted with data from five New York City hospitals; four for internal testing and one serving as external validation. We created novel DL models to classify Left Ventricular Ejection Fraction (LVEF) into categories derived from the latest universal definition of heart failure, estimate LVEF through regression, and predict a composite outcome of either RV systolic dysfunction or RV dilation. Results We obtained echocardiogram LVEF estimates for 147,636 patients paired to 715,890 ECGs. We used Natural Language Processing (NLP) to extract RV size and systolic function information from 404,502 echocardiogram reports paired to 761,510 ECGs for 148,227 patients. For LVEF classification in internal testing, Area Under Curve (AUC) at detection of LVEF<=40%, 40%<LVEF<=50%, and LVEF>50% was 0.94 (95% CI:0.94-0.94), 0.82 (0.81-0.83), and 0.89 (0.89-0.89) respectively. For external validation, these results were 0.94 (0.94-0.95), 0.73 (0.72-0.74) and 0.87 (0.87-0.88). For regression, the mean absolute error was 5.84% (5.82-5.85) for internal testing, and 6.14% (6.13-6.16) in external validation. For prediction of the composite RV outcome, AUC was 0.84 (0.84-0.84) in both internal testing and external validation. Conclusions DL on ECG data can be utilized to create inexpensive screening, diagnostic, and predictive tools for both LV/RV dysfunction. Such tools may bridge the applicability of ECGs and echocardiography, and enable prioritization of patients for further interventions for either sided failure progressing to biventricular disease. Keywords Artificial Intelligence, Deep Learning, Machine Learning, HFrEF, Right Ventricular Dilation, Right Ventricular Systolic Dysfunction, echocardiography, electrocardiogram, ECG, EKG, LVEF, Left Ventricular Ejection Fraction, Left Heart Failure, Right Heart Failure

scholarly journals Is left ventricular superior to right ventricular pacing in children with congenital or postoperative complete heart block?

2021 ◽  
Author(s):  
Ch Bharat Siddharth ◽  
Jay Relan
Keyword(s):  
Right Ventricular ◽  
Heart Block ◽  
Complete Heart Block ◽  
Left Ventricular ◽  
Lv Function ◽  
Ventricular Pacing ◽  
Cross Sectional ◽  
Right Ventricular Pacing ◽  
Rv Pacing

Summary A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was ‘Is left ventricular superior to right ventricular pacing in children with congenital or postoperative complete heart block?’ Altogether, 19 papers were found using the reported search, of which 9 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. Two large multicentric showed that site of pacing was the major determinant of left ventricular (LV) function with LV pacing being superior to RV pacing, though the number of patients paced via LV was lesser in comparison to right ventricular (RV). There were 2 prospective, 2 retrospective and 1 cross-sectional studies with fewer patients that demonstrated superiority of LV over RV pacing in preserving LV function. Only 1 small-scale retrospective study showed similar results of LV and RV pacing on LV function. One cross-sectional study showed superiority of LV apical pacing on exercise tolerance. As per the existing literature, LV apex seems to be the most optimal site for epicardial pacing while RV free wall pacing has the highest risk of causing LV dysfunction over the long term. We conclude that LV pacing appears to be superior to RV pacing in terms of long-term effect on cardiac function and ventricular synchrony.

scholarly journals Right ventricular free wall strain in acutely decompensated heart failure patients with ischemic and non-ischemic cardiomyopathy

2021 ◽  
Author(s):  
Dino Mirić ◽  
Ana Barac ◽  
Vesna Čapkun ◽  
Darija Baković Kramarić
Keyword(s):  
Heart Failure ◽  
Right Ventricular ◽  
Nyha Class ◽  
Global Longitudinal Strain ◽  
Decompensated Heart Failure ◽  
Left Ventricular ◽  
Laboratory Evaluation ◽  
Lv Function ◽  
Free Wall ◽  
Class Iii

Aims. Right ventricular (RV) dysfunction is a predictor of adverse outcomes among patients with HF with reduced ejection fraction (HFrEF) however, differences in RV parameters in HFrEF patients with ischemic (ICM) and non-ischemic cardiomyopathies (NICM) are not well understood. We investigated echocardiographic characteristics, including RV strain, in patients with acute decompensated heart failure (ADHF) and compared patients with ICM and NICM etiology. Methods. Consecutive patients who presented with ADHF and NYHA class III-IV were prospectively enrolled if they had LVEF <40% and history of ICM or NICM. All patients underwent clinical exam, laboratory evaluation and 2-D echocardiographic assessment of the left ventricular (LV) and RV function, LV and RV global longitudinal strain (LVGLS, RVGLS), and RV free wall strain (RVfwLS). Results. Of 84 patients, 44 had ICM and 40 NICM. The groups had similar blood pressure, NT-proBNP, and echocardiographic parameters of LV function including LVGLS. Absolute RVGLS values were lower than RVfwLS values in both groups. Patients with NICM had significantly lower RVfwLS, but not RVGLS, compared to patients with ICM (-13% to -17%, P=0.006). Similar differences in RVfwLS were seen in patients in NYHA class III (NICM vs ICM: -13% and -17%, respectively, 95% CI: -8.5 to -0.5) and NYHA class IV (NICM vs ICM: -13.8% and -17%, respectively, 95% CI: -6.4 to -0.59). Conclusion. Among patients hospitalized with ADHF, patients with nonischemic etiology compared with the patients with ICM, have worse RV dysfunction measured by RVfwLS, despite similar extent of LV impairment and the same functional limitation class.

scholarly journals Deleterious effect of right ventricular pacing in patients with cardiac transthyretin amyloidosis: potential clinical benefit of cardiac resynchronization therapy

2020 ◽  
Vol 4 (3) ◽  
pp. 1-5
Author(s):  
David Aouate ◽  
Aymeric Menet ◽  
Dimitri Bellevre ◽  
Thibaud Damy ◽  
Sylvestre Marechaux
Keyword(s):  
Heart Failure ◽  
Cardiac Resynchronization Therapy ◽  
Right Ventricular ◽  
Cardiac Amyloidosis ◽  
Left Ventricular ◽  
Cardiac Resynchronization ◽  
Ventricular Pacing ◽  
Resynchronization Therapy ◽  
Transthyretin Amyloidosis ◽  
Rv Pacing

Abstract Background Cardiac amyloidosis involvement is associated with a detrimental outcome including frequent arrhythmias, heart failure, and conduction disturbances which may need permanent pacing. Cases summary We report two cases of patients with transthyretin amyloidosis (ATTR) who developed heart failure and depressed left ventricular ejection fraction (LVEF) following permanent right ventricular (RV) pacing but highly responded to cardiac resynchronization therapy (CRT). Discussion The impact of RV pacing and CRT in cardiac amyloidosis is not known. In our cases, the detrimental effect of permanent RV pacing on left ventricular (LV) systolic function and heart failure symptoms was suggested by both permanent RV pacing mediated functional and LV function decline and LV systolic dysfunction reversal following CRT along with QRS width reduction. Whether cardiac resynchronization should be readily recommended in ATTR patients who need ventricular pacing whatever the LVEF deserves further investigation.

scholarly journals New Onset Heart Failure after Right Ventricular Pacing in Patients with Normal Left Ventricular Function

2021 ◽  
Vol 10 (1) ◽  
pp. 365-369
Author(s):  
Fawad Qadir ◽  
Muhammad Shahid ◽  
Hadi Yousuf Saeed ◽  
Muhammad Tahir Mohyudin ◽  
Abu Bakar Ali Saad ◽  
...  
Keyword(s):  
Heart Failure ◽  
Right Ventricular ◽  
Left Ventricular ◽  
Lv Function ◽  
Av Block ◽  
Ventricular Pacing ◽  
Right Ventricular Pacing ◽  
Normal Left Ventricular ◽  
New Onset

Background: Cardiac pacing is the best optional treatment for cardiac rhythm disturbances such as cardiac arrhythmias, high grade atrioventricular (AV) block and heart failure (HF). Right ventricular apical (RVA) pacing in patients with normal left ventricular heart, may stimulate HF and cardiomyopathy. The objective of this study was to determine the frequency of new-onset heart failure after right ventricular apical pacing in patients having normal left ventricular (LV) function. Material and Methods: This prospective study was conducted from March 2017 to January 2019 in Chaudhry Pervaiz Elahi (CPE) Institute of Cardiology, Multan Pakistan. Adult patients (n=50) who fulfilled the American College of Cardiology (ACC) guidelines for permanent pacemaker (PPM) insertion and with normal LV function were included in this study. Pacemaker was implanted in all patients under local anesthesia. All patients were followed up for six months to determine the occurrence of heart failure. 2-D echocardiography was done to determine heart failure at follow up in pacemaker clinic. Results: Mean age of the study participants was 50.53 ± 6.75 years with male predominance. Mean pre-implantation ejection fraction (EF%) was 55.4 ± 4.2%. Main reason of PPM insertion was third degree AV block followed by right bundle branch block (RBBB). Incidence of HF was 4% at 06 months’ follow-up. Mortality occurred only in 1 (2%) patient. Conclusions: Right ventricular pacing is associated with risk of new onset heart failure in long term follow-up. In the present study, HF developed in 4% patients in a follow-up period of six months

scholarly journals Adverse Consequences of Right Ventricular Apical Pacing and Novel Strategies to Optimize Left Ventricular Systolic and Diastolic Function

2019 ◽  
Vol 15 (2) ◽  
pp. 145-155 ◽  
Author(s):  
Mohammad Reeaze Khurwolah ◽  
Jing Yao ◽  
Xiang-Qing Kong
Keyword(s):  
Right Ventricular ◽  
Systolic Function ◽  
Left Ventricular ◽  
Cardiac Resynchronization ◽  
Lv Function ◽  
Ventricular Dyssynchrony ◽  
Lv Dysfunction ◽  
Rv Pacing ◽  
Systolic And Diastolic Function

Several studies have focused on the deleterious consequences of Right Ventricular Apical (RVA) pacing on Left Ventricular (LV) function, mediated by pacing-induced ventricular dyssynchrony. Therapeutic strategies to reduce the detrimental consequences of RVA pacing have been proposed, that includes upgrading of RVA pacing to Cardiac Resynchronization Therapy (CRT), alternative 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 outcomes of patients with RV septal pacing will be explored.

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