Farouq Maiwand, Rorsman Cecilia, Marinko Sofia, Mörtsell David, Chaudhry Uzma, Wang Lingwei, Platonov Pyotr, Borgquist Rasmus
Cardiology Section, Department of Clinical sciences, Lund University, Lund, Sweden.
Arrhythmia Section, Skane University Hospital, Lund, Sweden.
Heart Rhythm O2. 2024 Jul 23;5(9):623-630. doi: 10.1016/j.hroo.2024.07.012. eCollection 2024 Sep.
Studies have shown that the risk of new-onset heart failure (HF) is higher postimplantation for patients receiving right ventricular pacing.
This study aimed to investigate incidence, risk factors, and implications for long-term prognosis of new-onset HF in patients after pacemaker implantation.
Patients without pre-existing HF who received a pacemaker in Sweden during the period of 2005 to 2020 were identified via the nationwide Pacemaker Registry. Data were crossmatched with the population registry and national disease registries. The primary outcome was new-onset HF within 5 years, and a risk score for this was developed and validated.
In all, 65,579 patients met the inclusion criteria (10,351 single-chamber ventricular and 55,228 dual-chamber pacemakers). A total of 13,792 (21.0%) patients were diagnosed with HF within 5 years postimplantation. Of these, 6244 (45.3%) were hospitalized for HF. Patients with new-onset HF were more likely to die within 5 years (41.2% vs 19.7%, < .0001). Risk factors for new-onset HF included increasing age, male sex, hypertension, diabetes, atrial fibrillation, chronic lung and kidney disease, ischemic heart disease, and atrioventricular block. In a combined score using these variables, patients in the highest risk-score quartile had a hazard ratio of 5.36 (95% CI 4.91-5.86, < .001) and an absolute risk of 32% for developing HF.
Pacemaker therapy is associated with >20% risk of new-onset HF within 5 years, and we identified 9 risk factors associated with the diagnosis of new-onset HF. The proposed score based on these variables can be used to identify patients at high risk for new-onset HF.
研究表明，接受右心室起搏的患者植入后新发心力衰竭（HF）的风险更高。
本研究旨在调查起搏器植入术后患者新发HF的发生率、危险因素及其对长期预后的影响。
通过全国起搏器登记处识别2005年至2020年期间在瑞典接受起搏器植入且既往无HF的患者。数据与人口登记处和国家疾病登记处进行交叉匹配。主要结局是5年内新发HF，并为此制定和验证了风险评分。
共有65579例患者符合纳入标准（10351例单腔心室起搏器和55228例双腔起搏器）。共有13792例（21.0%）患者在植入后5年内被诊断为HF。其中，6244例（45.3%）因HF住院。新发HF患者在5年内死亡的可能性更高（41.2%对19.7%，P<0.0001）。新发HF的危险因素包括年龄增加、男性、高血压、糖尿病、心房颤动、慢性肺和肾脏疾病、缺血性心脏病和房室传导阻滞。在使用这些变量的综合评分中，处于最高风险评分四分位数的患者发生HF的风险比为5.36（95%CI 4.91-5.86，P<0.001），绝对风险为32%。
起搏器治疗与5年内新发HF风险>20%相关，我们确定了9个与新发HF诊断相关的危险因素。基于这些变量提出的评分可用于识别新发HF的高危患者。
