Abstract 10177: Pacing-Induced Cardiomyopathy: A Systematic Review and Meta-Analysis of Definition, Incidence, Risk Factors and Management

Abstract

Introduction: Pacing-induced cardiomyopathy (PiCM) is a potential adverse sequela of right ventricular pacing. Definition varies between studies and the optimal management approach is uncertain. We aimed to characterize definition, incidence, risk factors and treatment strategies of PiCM. Methods: We performed a systematic review and meta-analysis of human studies that evaluated PiCM following pacemaker implantation identified through a literature search of PubMed and EMBASE up to March 2022. Included studies had fifty or more participants. We collected data regarding study definition of PiCM and calculated pooled prevalence across studies. Meta-analysis with random-effects modelling was used to assess association between risk factors and PiCM, reported as odds ratio (OR) with 95% confidence interval (CI). Results: Twenty-six studies (six prospective studies) with a total of 57993 patients (mean/median age 51-78 years, female 45%) were included in final analysis. Fifteen unique definitions of PiCM were reported; the most common definition was left ventricular ejection fraction (LVEF) <50% and LVEF decline ≥10% after pacemaker insertion. Pooled prevalence of PiCM was 12% (95%CI, 11-14%; Figure 1). On meta-analyses, risk factors included male sex (OR 1.23 95%CI 1.12-1.35), baseline LVEF (OR 0.95 per 1% increase, 95%CI 0.93-0.97), paced QRS complex duration (OR 1.02 per msec, 95%CI 1.01-1.03) and right ventricular pacing (RVP) burden (OR 1.02 per 1% increase, 95%CI 1.01-1.02). Treatment strategies identified included cardiac resynchronisation therapy (five studies) and his bundle pacing (three studies). Conclusions: Definition of PiCM varied significantly between studies. More than one in ten patients with a pacemaker with RV pacing developed PiCM. Risk factors included male sex, baseline LVEF, paced QRS duration and RVP. The optimal management strategy is not yet established. Further research is needed to define and treat this understated complication.