Revisiting predictors of worse atrioventricular valve and left ventricular systolic function following pacemaker therapy.

Abstract

Predictors of worsening atrioventricular valve regurgitation and left ventricular (LV) systolic function after implantation of a leadless pacemaker (LPM) remain unclear compared with those of a transvenous pacemaker (TPM). We retrospectively analyzed 205 patients who were newly implanted with a permanent pacemaker (119 LPMs and 86 TPMs) and underwent transthoracic echocardiography before and 8±5 months after implantation. We evaluated the worsening of tricuspid and mitral regurgitation (TR and MR), defined as at least one-grade aggravation in severity, and changes in LV ejection fraction (LVEF). Worsening TR occurred more frequently in the LPM group compared to the TPM group (33%vs. 20%, p=.04); however, there was no significant difference between the two groups regarding worsening MR (26%vs. 18%, p=.18) and LVEF change (-2±10%vs. -3±8%, p=.40). In multivariable analysis, independent predictors for worsening TR, MR, and LVEF after implantation were found to be (1) the change from sinus rhythm at baseline to atrioventricular asynchronous right ventricular (RV) pacing (odds ratio [OR]: 5.68, 95% confidence interval [CI]: 1.94-16.70, p<.01); (2) the change from non-pacing ventricular contraction at baseline to RV pacing (OR: 2.42, 95% CI: 1.12-5.24, p=.02); and (3) a higher RV pacing burden (β: -0.05, 95% CI: -0.08--0.02, p<.01), respectively. Worsening TR, MR, and LVEF after pacemaker implantation were not associated with the type of pacing device but loss of atrioventricular synchrony or dependency on RV pacing.