Incidence and predictors of pacemaker-induced cardiomyopathy with right ventricular pacing: a systematic review

ABSTRACT

Introduction

This systematic review aims to evaluate the incidence and predictors of pacemaker-induced cardiomyopathy (PICM) in patients undergoing right ventricular pacing.

Areas covered

A literature review was conducted using MeSH terms (Right ventricular pacing, Pacemaker-related cardiomyopathy, Pacemaker-induced cardiomyopathy) in PubMed, EMBASE, Web of science CINAHL, and the Cochrane Library until October 2021. All data reporting the incidence of PICM after implantation of right-sided pacemakers or implantable cardioverter-defibrillator (ICD) were retrieved from the eligible studies.

Expert opinion

Out of 3,625 articles, 20 studies met the inclusion criteria that included 5,381 patients. . The mean age of the patients ranged between 55.8 ± 13.5 and 77.4 ± 10.8 years. The mean incidence of PICM was 25.7%. Mean ejection fraction (EF) at baseline ranged from 48 ± 1% and 62.1 ± 11.2%, while mean EF at follow-up ranged between 33.7 ± 7.4% and 53.2 ± 8.2%. Three studies reported a decline of >20% EF at follow-up. RV pacing was associated with a considerable risk of PICM, with biological factors, such as male gender, old age, increased QRS duration, and chronic RV pacing burden playing an important role in the development of disease.

KEYWORDS:

• Heart failure
• electrophysiology
• left bundle branch block
• wide QRS
• LV dyssynchrony

Article highlights

• Conventional right ventricular pacing can have a significant long-term impact on various hemodynamic and functional parameters of the heart

• This systematic review consisted of 20 studies, recruiting 5,381 patients with right ventricular pacing

• In the qualitative synthesis, the mean incidence of PICM was 25.7% in the patient cohort

• Male gender, old age, increased QRS duration, and chronic RV pacing burden were the predictors of developing PICM

Author contribution

JA: first draft, supervision; ZZ: first draft, methodology; FW: first draft, search strategy; ZW: methodology, literature search; JM: concept, final draft, literature search; DIS: first draft; SMJZ: literature search, final draft.

Declaration of interests

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.