Mannion James, Hong Kathryn L, Hennessey Amy, Cleary Anna, Subramaniyan Anand, Sheahan Conor, Bennett Kathleen E, Sheahan Richard
Electrophysiology Department, Beaumont Hospital, Beaumont, Dublin 9, Ireland.
Cambridge University Hospitals NHS Foundation Trust, Cambridge, Cambridgeshire, CB2 0QQ, UK.
Cardiol Res. 2024 Apr;15(2):99-107. doi: 10.14740/cr1598. Epub 2024 Apr 15.
Right ventricular (RV) pacing is established as the most common ventricular pacing (VP) strategy for patients with symptomatic bradyarrhythmia. Some patients with high VP burden suffer deterioration of left ventricular (LV) function, termed pacing-induced cardiomyopathy (PICM). Patients who pace > 20% of the time from the RV apex are at increased risk of PICM, but independent predictors of increased RV pacing burden have not been elucidated in those who have a permanent pacemaker (PPM) inserted for bradyarrhythmia.
We aimed to identify factors that are associated with increased VP burden > 20%, hence determining those at risk for resultant PICM. In this retrospective cohort study, we identified the most recent 300 consecutive cardiac implantable electronic device (CIED) implants in our center and collected past medical history, electrocardiogram (ECG), echo, medication and pacemaker check data.
A total of 236 individuals met inclusion criteria. Of the patients, 35% had RV pacing burden < 20%, while 65% had VP burden ≥ 20%; 96.2% of patients with complete heart block (CHB) paced > 20% (P = 0.002). Utilization of DDD or VVI (75.2% and 89.2% of patients, respectively) without mode switch algorithms was associated with VP > 20% (P < 0.001). Male or previous coronary artery bypass grafting (CABG) patients also statistically paced > 20%. Other factors trending towards significance included prolonged PR interval, atrial fibrillation or more advanced age.
High-grade atrioventricular (AV) block was associated with an RV pacing burden > 20% over 3 years but this was not consistent in patients with only transient episodes of high-grade AV block. We found a significant association between high VP% and male sex, previous CABG and the absence of mode switching algorithms.
右心室（RV）起搏是有症状性缓慢性心律失常患者最常用的心室起搏（VP）策略。一些VP负荷高的患者会出现左心室（LV）功能恶化，称为起搏诱导性心肌病（PICM）。右心室心尖部起搏时间超过20%的患者发生PICM的风险增加，但对于因缓慢性心律失常植入永久起搏器（PPM）的患者，右心室起搏负荷增加的独立预测因素尚未明确。
我们旨在确定与VP负荷增加>20%相关的因素，从而确定那些有发生PICM风险的因素。在这项回顾性队列研究中，我们确定了本中心最近连续植入的300例心脏植入式电子设备（CIED），并收集了既往病史、心电图（ECG）、超声心动图、用药及起搏器检查数据。
共有236例个体符合纳入标准。其中，35%的患者右心室起搏负荷<20%，而65%的患者VP负荷≥20%；96.2%的完全性心脏传导阻滞（CHB）患者起搏>20%（P = 0.002）。使用无模式转换算法的DDD或VVI（分别占患者的75.2%和89.2%）与VP>20%相关（P < 0.001）。男性或既往有冠状动脉旁路移植术（CABG）的患者在统计学上起搏也>20%。其他有显著趋势的因素包括PR间期延长、心房颤动或年龄较大。
高度房室（AV）阻滞与3年以上右心室起搏负荷>20%相关，但在仅有短暂高度AV阻滞发作的患者中并不一致。我们发现高VP%与男性、既往CABG以及缺乏模式转换算法之间存在显著关联。
