What is the clinical evidence from this study?

Study design: Review. Population: Pacing-induced cardiomyopathy.

What question did this study set out to answer?

This review aims to explore pacing-induced cardiomyopathy, its underlying mechanisms, risk factors, and treatment options.

February 28, 2026

Pacing-induced cardiomyopathy: A narrative review

Key Result

Effective risk stratification for pacing-induced cardiomyopathy can help identify adult patients who may benefit from early use of cardiac physiologic pacing or CRT to prevent pathologic remodeling.

Key Points

This review aims to explore pacing-induced cardiomyopathy, its underlying mechanisms, risk factors, and treatment options.
Conducted a narrative review of existing literature on pacing-induced cardiomyopathy.
Examined definitions, prevalence, pathophysiology, risk factors, and treatment methods.
Analyzed challenges in identifying at-risk patients for de novo cardiac resynchronization therapy.
Pacing-induced cardiomyopathy leads to left ventricular dysfunction and heart failure due to adverse remodeling.
Effective risk stratification can facilitate early treatment through cardiac physiologic pacing or CRT.
Prevalence assessment is hindered by variability in lead implantation and pacing options across centers.

Structured PICO

Population

Adult populations with or at risk for pacing-induced cardiomyopathy

Intervention

Cardiac resynchronization therapy (CRT) and cardiac physiologic pacing

Effective risk stratification can help identify patients who may benefit from early use of cardiac physiologic pacing or CRT to prevent pacing-induced cardiomyopathy.

Limitations

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.

Abstract

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.

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