Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
Department of Cardiology, Chi Mei Medical Center, Tainan, Taiwan.
Med Sci Monit. 2024 May 22;30:e944114. doi: 10.12659/MSM.944114.
BACKGROUND Long-term right ventricular (RV) pacing has been linked to left atrial enlargement (LAE). The incidence and risk factors associated with significant LAE after RV pacing remain unknown. This retrospective study included 461 patients requiring RV pacing at 2 centers between 2012 and 2020 and aimed to evaluate the incidence, risk factors, outcomes, and complications of LAE. MATERIAL AND METHODS A total of 461 patients with normal-sized pre-implant left atrial dimension and dual-chamber pacing pacemaker implantation for complete atrioventricular block were enrolled. Patients were grouped based on a ≥20% increase from their baseline left atrial dimension by echocardiography, indicating significant LAE, and initial characteristics, echocardiographic data, and outcomes were compared. RESULTS During a mean 7.0±4.9 years follow-up period, 96 patients (20.8%) developed significant LAE, whereas 365 patients did not. In multivariate logistic regression analysis, smaller pre-implant left atrial dimension (OR, 0.776; 95% CI, 0.728-0.828; P<0.001), lower post-implant left ventricular ejection fraction (OR, 0.976; 95% CI, 0.957-0.995; P=0.014), post-implant development of moderate to severe mitral regurgitation (OR, 2.357; 95% CI, 1.172-4.740; P=0.016), and RV pacing duration ≥3.3 years (OR, 1.576; 95% CI, 1.039-2.646; P=0.045) were independent predictors of significant LAE after RV-dependent pacing. There was a significant difference in the incident stroke events between patients without and with significant LAE (9.9% vs 17.7%; log-rank P=0.047). CONCLUSIONS Long-term RV pacing was linked to significant LAE in 20.8% of patients with complete atrioventricular block, with those affected experiencing a higher stroke rate during follow-up.
长期右心室（RV）起搏与左心房扩大（LAE）有关。RV 起搏后发生明显 LAE 的发生率和相关危险因素尚不清楚。本回顾性研究纳入了 2012 年至 2020 年间在 2 个中心因完全性房室传导阻滞需要 RV 起搏的 461 例患者，旨在评估 LAE 的发生率、危险因素、结局和并发症。
共纳入 461 例植入具有正常左心房大小和双腔起搏器的患者，这些患者因完全性房室传导阻滞植入 RV 起搏。根据超声心动图基线左心房大小增加≥20%（提示 LAE），将患者分为两组，并比较初始特征、超声心动图数据和结局。
在平均 7.0±4.9 年的随访期间，96 例（20.8%）患者发生明显 LAE，而 365 例患者未发生。多变量 logistic 回归分析显示，植入前较小的左心房大小（OR，0.776；95%CI，0.728-0.828；P<0.001）、植入后较低的左心室射血分数（OR，0.976；95%CI，0.957-0.995；P=0.014）、植入后出现中重度二尖瓣反流（OR，2.357；95%CI，1.172-4.740；P=0.016）和 RV 起搏持续时间≥3.3 年（OR，1.576；95%CI，1.039-2.646；P=0.045）是 RV 依赖起搏后发生明显 LAE 的独立预测因素。无明显 LAE 患者和有明显 LAE 患者的卒中事件发生率存在显著差异（9.9%比 17.7%；log-rank P=0.047）。
在因完全性房室传导阻滞而接受 RV 起搏的患者中，20.8%的患者出现明显的 LAE，且在随访过程中这些患者的卒中发生率更高。
