Patients with long-term permanent pacemakers have a high prevalence of left ventricular dysfunction.

INTRODUCTION

Patients with right ventricular pacemakers are at increased risk of left ventricular systolic dysfunction (LVSD). We aimed to establish the prevalence, degree and associations of LVSD in patients with long-term right ventricular pacemakers listed for pulse generator replacement (PGR).

METHODS

All patients listed for PGR at Leeds General Infirmary were invited to attend for an assessment during which we recorded medical history, symptomatic status, medical therapy, date and indication of first implantation, the percentage of right ventricular pacing (% RVP) and an echocardiogram.

RESULTS

We collected data on 491 patients. A left ventricular ejection fraction less than 50% was observed in 40% of our cohort, however, this was much higher (59%) in those with more than 80% RVP than in those with less than 80% RVP (22%) (P < 0.0001). Multivariable analysis revealed % RVP, (but not complete heart block at baseline), serum creatinine and previous myocardial infarction to be independently related to the presence of LVSD. A model combining % RVP and previous myocardial infarction has a c-statistic of 0.74 for predicting LVSD. After a mean follow-up time of 668 days, 56 patients (12%) were dead or had been hospitalized for heart failure. In multivariable analysis, previous myocardial infarction and high % RVP were independently associated with a worse survival.

CONCLUSION

Patients with right ventricular pacemakers have a high prevalence of LVSD, and this is greater in those exposed to more RVP. Those with LVSD and high amounts of RVP are at higher risk of hospitalization or death. Simple variables can identify those patients who might benefit from a more comprehensive review.