Vivantes Klinikum im Friedrichshain und Am Urban, Berlin, Germany.
Rostock University Medical Center, Rostock, Germany.
Eur J Med Res. 2019 Jul 22;24(1):23. doi: 10.1186/s40001-019-0386-5.
Data concerning the effect of chronic right ventricular pacing in patients with normal left ventricular ejection fraction (LVEF%) are contradictory. The aim of this study is to evaluate the prevalence of pacing-induced cardiomyopathy (PICM) at midterm follow-up after permanent pacemaker implantation (PPM).
A series of 170 patients were submitted to PPM within our facility. Inclusion criteria were the absence of structural heart disease and a preserved LVEF% (> 45%) at the time of PPM. A midterm clinical and echocardiographic follow-up was performed, and data were collected and analyzed retrospectively. PICM was defined as follow-up LVEF ≤ 45%, dyskinesia during RV pacing, and the absence of other known causes of cardiomyopathy.
At a median echocardiographic follow-up of 24.5 months (IQR 10.0-43.0 months), the overall mean LVEF% decreased from a preimplantation value of 66.7% (± 8.6%) to 63.2% (± 10.6%) (p < 0.0001). PICM occurred in 11 patients (6.5%). Patients developing PICM had a significantly lower preimplantation LVEF% (58.4 ± 8.0% vs. 67.3 ± 8.4%; p = 0.005), a trend for higher right ventricular pacing time rate (0.7 ± 0.3 vs. 0.5 ± 0.4; p = 0.1), a significantly lower rate of PPM indication for sick sinus syndrome (SSS) (18.2% vs. 61.0%; p = 0.009), and significantly higher rate of second-grade cardiac conduction block (36.4% vs. 11.3%; p = 0.03). At multivariate logistic regression, only preimplantation LVEF% (OR = 0.88; CI 0.80-0.96; p = 0.006) and the presence of SSS (OR = 0.1; CI 0.03-0.9; p = 0.04) were independently related (inverse relationship) to follow-up PICM.
In this selected PPM patient cohort with preserved LVEF%, the rate of PICM at midterm follow-up is relatively low, but its occurrence seems to be related to baseline LVEF% and PPM indication category.
关于慢性右心室起搏对射血分数正常（LVEF%）患者的影响的数据存在争议。本研究的目的是评估在永久性起搏器植入（PPM）后中期随访期间起搏诱导性心肌病（PICM）的发生率。
我们对 170 例在我院接受 PPM 的患者进行了一系列研究。纳入标准为在 PPM 时无结构性心脏病和保留的 LVEF%（>45%）。进行了中期临床和超声心动图随访，并回顾性收集和分析数据。起搏诱导性心肌病定义为随访时 LVEF≤45%、右心室起搏时出现运动障碍以及无其他已知的心肌病原因。
在中位超声心动图随访 24.5 个月（IQR 10.0-43.0 个月）时，整体平均 LVEF%从植入前的 66.7%（±8.6%）下降至 63.2%（±10.6%）（p<0.0001）。11 例（6.5%）患者发生起搏诱导性心肌病。发生起搏诱导性心肌病的患者植入前 LVEF%明显较低（58.4±8.0% vs. 67.3±8.4%；p=0.005），右心室起搏时间率呈升高趋势（0.7±0.3 比 0.5±0.4；p=0.1），起搏器植入的主要适应证为病态窦房结综合征（SSS）的比例较低（18.2% vs. 61.0%；p=0.009），而二级心脏传导阻滞的比例较高（36.4% vs. 11.3%；p=0.03）。多变量逻辑回归分析表明，只有植入前 LVEF%（OR=0.88；CI 0.80-0.96；p=0.006）和 SSS 的存在（OR=0.1；CI 0.03-0.9；p=0.04）与随访时的起搏诱导性心肌病独立相关（呈负相关）。
在本项研究中，对射血分数保留的选择 PPM 患者队列进行了中期随访，起搏诱导性心肌病的发生率相对较低，但它的发生似乎与基线 LVEF%和 PPM 适应证类别有关。
