Abdin Amr, Yalin Kivanc, Zink Matthias Daniel, Napp Andreas, Gramlich Michael, Marx Nikolaus, Schuett Katharina
University Hospital RWTH Aachen, Department of Cardiology, Angiology and Critical Care (Medical Clinic 1), Aachen, Germany.
Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Department of Cardiology, Istanbul, Turkey.
J Electrocardiol. 2019 Nov-Dec;57:31-34. doi: 10.1016/j.jelectrocard.2019.08.016. Epub 2019 Aug 23.
Pacemaker induced Cardiomyopathy (PICM) is an easily overlooked cause of heart failure with reduced ejection fraction. Data regarding this complication are sparse. Therefore, the aim of this study was to identify the incidence and predictors of PICM.
Between 2011 and 2017, 857 consecutive patients undergoing pacemaker (PM) implantation, were reviewed, and according to our inclusion criteria 173 individuals were enrolled in this retrospective single center study. All patients included had normal left ventricular ejection fraction (LVEF) before implantation, underwent single-chamber ventricular or dual-chamber PM implantation, had RV pacing burden ≥20%, and repeated echocardiogram was available ≥1 year after implantation. PICM was defined as deterioration LVEF ≥10%, resulting in LVEF <50%, which cannot be explained by other causes.
During a mean follow-up of 39.9 ± 21.0 months, PICM occurred in 26 patients (16%). RV pacing percentage did not differ significantly between the both groups (76.5 vs 76.2%, p = 0.65). The PICM group patients were likely to be men (p = 0.002) and had a lower rate of arterial hypertension (p = 0.01). Multivariate analysis revealed male sex (HR 6.45, 0.95 CI 1.90-21.86, p = 0.003) and wider paced QRS complex (HR 1.04, 95% CI 1.02-1.07, p < 0.001) as predictors of PICM.
In patients with frequent RV pacing, the prevalence of PICM is not uncommon. Male sex and wider paced QRS complex are independent predictors of PICM and these patients may require closer follow-up.
起搏器诱导的心肌病（PICM）是射血分数降低的心力衰竭的一个容易被忽视的原因。关于这一并发症的数据很少。因此，本研究的目的是确定PICM的发生率和预测因素。
回顾2011年至2017年间连续857例行起搏器（PM）植入术的患者，根据纳入标准，173例患者纳入本回顾性单中心研究。所有纳入患者植入前左心室射血分数（LVEF）正常，接受单腔心室或双腔PM植入，右心室起搏负担≥20%，植入后≥1年可进行重复超声心动图检查。PICM定义为LVEF恶化≥10%，导致LVEF<50%，且不能用其他原因解释。
在平均39.9±21.0个月的随访期间，26例患者（16%）发生PICM。两组间右心室起搏百分比无显著差异（76.5%对76.2%，p=0.65）。PICM组患者男性居多（p=0.002），动脉高血压发生率较低（p=0.01）。多变量分析显示男性（HR 6.45，95%CI 1.90-21.86，p=0.003）和更宽的起搏QRS波群（HR 1.04，95%CI 1.02-1.07，p<0.001）是PICM的预测因素。
在右心室频繁起搏的患者中，PICM的发生率并不罕见。男性和更宽的起搏QRS波群是PICM的独立预测因素，这些患者可能需要更密切的随访。
