Risk of hospitalisation for heart failure is increased in patients with chronic right ventricular pacing

Abstract

Evaluate the effect of right ventricular pacing on the incidence of heart failure in patients implanted for symptomatic bradycardia. The study was prospective and observational, including all consecutive patients implanted in our centre between 2014 January and 2017 December for symptomatic bradycardia. Heart failure diagnosis was based on clinical data, natriuretic peptides dosage and echocardiography. The follow up was done every 6 months. The cumulative heart failure rates were estimated using the Kaplan–Meier method, and variables associated with the risk of heart failure were identified by the Cox model. We included 736 patients, with a mean age of 76.6 ± 8.3 years, and 56.6% of men. Five hundred and three (68.3%) had a second or third atrio-ventricular block and the others a sinus node dysfunction. The proportions of NYHA class I, II, III and IV at inclusion were 28.6%, 49.7%, 17.4% and 4.3%, respectively. The mean left ventricular ejection fraction (LVEF) was 0.51 ± 0.10. After a median follow-up of 35.8 months, the cumulative rate of heart failure was 13.6% (CI 95%: 11.2%–16.0%). Predictive factors of heart failure occurrence were NYHA class (HR: 3.08; CI 95%: 2.45–4.41, for class II to IV versus class I); history of heart failure (HR: 2.10; CI 95%: 1.60–2.90); LVEF (HR: 2.13; CI 95%: 1.56–3.02, for LVEF ≤ 0.40 versus > 0.40); history of atrial fibrillation (HR: 1.48; CI 95%: 1.1–2.25); the percentage of ventricular pacing (HR: 3.26; CI 95%: 2.11–5.43; for %VP ≥ 90% versus < 90%); the paced QRS duration (HR: 2.14; CI 95%: 1.34–3.26; for QRS duration ≥ 160 msec versus < 160 msec). Right ventricular pacing is independently associated with the risk of heart failure. Using algorithms minimising unnecessary right ventricular pacing and cardiac resynchronisation therapy in some cases could reduce the incidence of the “pacing induced cardiomyopathy”.