Pacing-induced cardiomyopathy: A narrative review

Pacemaker implantation rates are increasing worldwide, raising concerns about pacing-induced cardiomyopathy a complication of chronic right ventricular pacing (RVP). Pacing-induced cardiomyopathy results in adverse remodeling leading to left ventricular dysfunction and heart failure. pacing-induced cardiomyopathy treatment includes cardiac resynchronization therapy (CRT) and cardiac physiologic pacing upgrades, while preventative strategies include de novo implantation of CRT or cardiac physiologic pacing. Identification of patients who may be suitable for de novo CRT/cardiac physiologic pacing due to high risk for developing pacing-induced cardiomyopathy remains challenging, in part due to limited assessment of patient characteristics. A narrative review of pertinent literature was conducted to examine the definitions, pathophysiology, prevalence, risk factors, novel screening tools, and treatment options for pacing-induced cardiomyopathy in adult populations. Accurate assessment of pacing-induced cardiomyopathy prevalence is limited by center-to-center variability, as well as a variety of lead implantation sites and pacing options. Effective risk stratification, facilitated by a thorough collection and analysis of notable risk factors for pacing-induced cardiomyopathy, can help identify patients that may benefit from early use of cardiac physiologic pacing or CRT to prevent pathologic remodeling.