Abstract

BackgroundRight ventricular (RV) pacing is the standard treatment for symptomatic bradycardia. RV pacing is known to cause dyssyncrony. New treatment options like His bundle pacing enhance the focus on left ventricular dysfunction in patients with pacemakers.ObjectivesThe aim of this cross-sectional study was to obtain a real-life picture of the patients in a representative cohort of outpatients with permanent pacemakers. The prevalence and causes of left ventricular dysfunction (LVD) were explored.MethodsIn total, 1869 patients of a pacemaker outpatient clinic were screened for left ventricular systolic dysfunction by transthoracic echocardiography. All patients were interviewed for symptoms and cardiologist care. Percentages of RV pacing and underlying cardiac disease were recorded.ResultsA left ventricular ejection fraction (LVEF) under 45% was found in 207 (11.1%) of all patients. Predictive factors for a reduced LVEF were a high pacing rate and long-term pacing. LVD due to RV pacing was diagnosed in 3.4% of all patients. Only 845 patients (45%) reported that they regularly visited a cardiologist.ConclusionThere is a high prevalence of unknown LVD in a typical pacemaker cohort. Therefore, regular echocardiographic examinations should be performed in outpatients of pacemaker clinics.

Highlights

  • Introduction and backgroundImplantation of a permanent cardiac pacemaker is the only effective long-term therapy for patients with symptomatic bradycardia

  • In patients with left ventricular dysfunction (LVD) not explained by other common causes of heart failure such as coronary artery disease, valvular heart disease or extensive hypertension with a percentage of right ventricle (RV) pacing over 40%, RV pacing was considered to be the main cause of LVD

  • A significantly reduced left ventricular ejection fraction (LVEF) was already seen at a percentage of RV pacing >30%, with the lowest LVEF seen in patients with a percentage of RV pacing >90%

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Summary

Introduction

Implantation of a permanent cardiac pacemaker is the only effective long-term therapy for patients with symptomatic bradycardia. RV pacing causes electrical and mechanical dyssynchrony [15, 16] similar to that of left bundle branch block. This is associated with deleterious effects on cardiac function, resulting in atrial fibrillation, heart failure and death [13, 14, 18]. New treatment options like His bundle pacing enhance the focus on left ventricular dysfunction in patients with pacemakers. 1869 patients of a pacemaker outpatient clinic were screened for left ventricular systolic dysfunction by transthoracic echocardiography. Regular echocardiographic examinations should be performed in outpatients of pacemaker clinics

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