Abstract
PurposeRight ventricular pacing threshold (RVPT) may rise over time accompanied by the increased use of implantable cardiac pacemakers. However, risk factors for permanent RVPT increase are not fully clarified in patients without definite lead fracture and dislodgment. We aimed to evaluate the long-term performance of RV pacing leads and identify risk factors associated with the occurrence of permanent RVPT increase in this population.MethodsPatients with first implantation of cardiac pacemakers from January 2008 to June 2016 were consecutively enrolled. Follow-up for RVPT increase was until December 2017. The clinical data, specific data on the pacemaker implantation, and routine follow-up were retrieved.ResultsDuring a follow-up duration of 5.4 ± 2.1 years, permanent RVPT increase (except lead fracture and dislodgment) was found in 8.4% (87/1033) patients. Patients with permanent RVPT increase had higher prevalence of myocardial infarction (MI), diabetes, and the use of amiodarone. The risk factors independently associated with permanent RVPT increase were MI (HR = 1.094, 95% CI 1.014–1.180, p = 0.031), diabetes (HR = 2.804, 95% CI 1.064–3.775, p = 0.003). MI patients with RVPT increase had higher prevalence of multivessel disease and atrioventricular block. Diabetic patients with RVPT increase exhibited higher serum fasting blood glucose (FBG) and hemoglobin A1c (HbA1c) levels, which were correlated with the maximum RVPT (p < 0.001).ConclusionsOur data showed that permanent RVPT increases (except lead fracture and dislodgement) during long-term follow-up after pacemaker implantation. The likely risk factors predisposing to chronic permanent RVPT increase are MI and diabetes with higher FBG and HbA1c levels.
Highlights
With the aging population and improved quality of life, the implantation rate of cardiac pacemaker (PM) is increasing
With regard to the Right ventricular pacing threshold (RVPT) increase, interestingly, we noticed that risk factors associated with chronically permanent RVPT increase might be diabetes and myocardial infarction (MI), which might influence the excitability of the cardiac tissue and the extent of local tissue fibrosis
Kistler [5] and Medi [6] reported 4% patients and 2% patients with increased RVPT (> 2 V at 0.4 ms) at a 24-month follow-up and 6-month follow-up, respectively. These short-term observational studies along with our long-term follow-up findings supported that RVPT might increase in patients with modern leads, and a relevant permanent RVPT increase ≥ 2.5 V at 0.4 ms occurred in about 2–4% of patients
Summary
With the aging population and improved quality of life, the implantation rate of cardiac pacemaker (PM) is increasing. Some different possible risk factors, such as myocardial infarction (MI), hyperkalemia, or antiarrhythmic drugs associated with a higher incidence of RVPT increase, have been reported [7,8,9]. Systematic data on permanent RVPT increase after PM implantation are scarce, and data on pre-operative, peri-procedural, and post-operative characteristics associated with RVPT increase have not been fully clarified, especially in patients without definite lead fracture and dislodgement. The purpose of the present study is to characterize the chronic performance of RV pacing leads during long-term follow-up after PM implantation and to identify clinical risk factors associated with permanent RVPT increase in this population
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