Department of Cardiac Electrophysiology and Pacing, Christian Medical College, Vellore, India.
Department of Cardiac Electrophysiology and Pacing, Christian Medical College, Vellore, India.
Indian Heart J. 2021 Sep-Oct;73(5):582-587. doi: 10.1016/j.ihj.2021.07.011. Epub 2021 Aug 3.
Knowledge of factors causing pacing-induced cardiomyopathy (PICM) is incomplete. We sought to estimate the incidence and predisposing factors for PICM and evaluate if the risk they portend adds up.
Single centre retrospective study where consecutive patients with preserved LVEF undergoing pacemaker (PM) implantation between 2012 and 2018 were analysed.
A total of 749 patients (68.4 % male; mean age 59.2 ± 14.08 years) were included in the analysis. PICM developed in 74 (9.9%) patients over a median follow up of 2.2 years (IQR 1.1-3.2). Pre-implant LVEF, paced QRS duration and RV pacing burden were independent predictors of PICM. Using 90 % specificity cut-off values for LVEF and paced QRS, and the value separating lowest tertile of RV pacing from the higher tertiles, three risk factors were identified: (i) baseline LVEF < 55 %, (ii) paced QRS duration > 160 msec, and (iii) RV pacing burden > 33 %. Patients with two or more risk factors were at the highest risk (OR 11.62, 95 % CI 4.62-29.21, p-value < 0.001) for developing PICM while those with one risk factor had an intermediate risk (OR 3.89, 95 % CI 1.62-9.34, p-value 0.002) when compared to those without any risk factors.
Low-normal baseline LVEF, wider paced QRS and higher RV pacing burden independently predicted the development of PICM. The presence of ≥2 factors increased the odds of PICM, twelve-fold. A narrower paced QRS, the only modifiable risk factor may help mitigate development of PICM.
人们对导致起搏诱导性心肌病（PICM）的因素了解并不全面。本研究旨在评估 PICM 的发生率和易患因素，并评估其风险是否会累加。
本研究为单中心回顾性研究，纳入了 2012 年至 2018 年间连续因左心室射血分数保留而行起搏器（PM）植入的患者。
共纳入 749 例患者（68.4%为男性，平均年龄 59.2±14.08 岁），中位随访时间为 2.2 年（IQR 1.1-3.2）。74 例（9.9%）患者出现 PICM。植入前左心室射血分数、起搏 QRS 持续时间和右心室起搏比例是 PICM 的独立预测因子。使用 90%特异性截断值的 LVEF 和起搏 QRS 值，以及区分最低三分位 RV 起搏与较高三分位 RV 起搏的界值，确定了 3 个危险因素：（i）基础 LVEF<55%，（ii）起搏 QRS 持续时间>160msec，（iii）RV 起搏比例>33%。具有 2 个或更多危险因素的患者发生 PICM 的风险最高（OR 11.62，95%CI 4.62-29.21，p<0.001），而具有 1 个危险因素的患者发生 PICM 的风险居中（OR 3.89，95%CI 1.62-9.34，p=0.002），与无危险因素的患者相比。
正常低值基础 LVEF、更宽的起搏 QRS 和更高的 RV 起搏比例独立预测 PICM 的发生。存在≥2 个因素会使 PICM 的可能性增加 12 倍。更窄的起搏 QRS，唯一可改变的危险因素，可能有助于减轻 PICM 的发生。
