Pacing-induced cardiomyopathy in patients with permanent right ventricular pacing and preserved left ventricle systolic function: characteristics, methods of treatment and prevention

Abstract

The aim – to determine the frequency of occurrence and describe the characteristics of pacing-induced cardiomyopathy (PICM) in patients with permanent right ventricular pacing (at least 90 %) and preserved left ventricular ejection fraction (LVEF) (≥ 50 %).Materials and methods. The study included 34 patients with indications for permanent ventricular pacing who had pacemaker implantation from 2012 to 2022 (mean follow-up period was 44.97±28.45 months). PICM was defined as a decrease in LVEF < 45 % during follow-up.Results and discussion. The incidence of PICM in this study was 26 %. The average value of LVEF and EDI at the time of the control follow-up was significantly different in the PICM group and non-PICM group: 38.6±5.9 vs. 53.5±5.7 % (p<0.001) and 97.90±20.75 vs. 60.90±19.32 ml/m2 (p<0.001). All patients from the study group during follow-up went through protocol echocardiography, at which intraventricular and interventricular asynchrony were examined, the number of left ventricular segments with reduced deformation were fixed, and the global longitudinal deformation of the left ventricle (GLS) was calculated. The values of these parameters differed significantly in the PICM group and non-PICM group: intraventricular asynchrony was 261.1±61.0 vs. 146.1±62.8 ms (p<0.001), interventricular asynchrony 91.0±36.4 vs. 54.2±22.2 ms (p=0.014), the number of segments with reduced deformation 8.1±2.6 vs. 3.91±2.30 (p<0.001), GLS -9.7±2.6 vs. -14.9±3.4 (p<0.001). At the time of the follow-up examination, sensitivity on ventricular lead in the PICM group was significantly reduced compared to patients with preserved LVEF (6.26±4.02 vs. 11.56±3.86 mV; p=0.045). The paced QRS width in the PICM group was significantly greater (163.0±22.7 vs. 150.8±14.5; p=0.046) and there were more patients with rate-adapted cardiac pacing in the PICM group (4 (40 %) vs. 2 (8 %)), p=0.0305).Conclusions. According to the obtained data, cardiomyopathy due to right ventricular pacing develops rather instantaneously in the first years after PM implantation, rather than slowly progressing over time, although a multivariate regression analysis of risk factors for the development of PICM has yet to be performed on the obtained clinical data. Biventri­­­cular paicng effectively eliminates the consequences of non-physiological right ventricular myocardial paicng, improves LV systolic function. Conduction system pacing may potentially reduce the risk of right ventricular pacing-induced cardiomyopathy in patients with preserved LVEF.