November 22, 2022Journal of Clinical MedicineOpen Access

Cardiomyopathy Associated with Right Ventricular Apical Pacing-Systematic Review and Meta-Analysis

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Why the study?

Right ventricular apical pacing was thought to have a deteriorating effect on left ventricular systolic function, prompting a systematic assessment of randomized controlled trials to determine its effects on LVEF.

Does right ventricular apical pacing reduce left ventricular ejection fraction in patients with bradyarrhythmias?

Structured PICO

Does right ventricular apical pacing reduce left ventricular ejection fraction in patients with bradyarrhythmias?

Population

885 patients across 14 randomized controlled trials requiring artificial ventricular pacing for bradyarrhythmias

Intervention

Right ventricular apical pacing (RVAP)

Comparator

Baseline (pre-intervention)

Outcome

Left ventricular ejection fraction (LVEF)surrogate

Right ventricular apical pacing is associated with a statistically significant progressive deterioration of left ventricular systolic function, as measured by LVEF.

Implication

May warrant non-apical pacing sites to limit LVEF loss; reinforces meta-analytic evidence for pacing effects in bradyarrhythmias.

Abstract

AIMS: Bradyarrhythmias are potentially life-threatening medical conditions. The most widespread treatment for slow rhythms is artificial ventricular pacing. From the inception of the idea of artificial pacing, ventricular leads were located in the apex of the right ventricle. Right ventricular apical pacing (RVAP) was thought to have a deteriorating effect on left ventricular systolic function. The aim of this study was to systematically assess results of randomized controlled trials to determine the effects of right ventricular apical pacing on left ventricular ejection fraction (LVEF). METHODS: we systematically searched the Cochrane Central Register of Controlled Trials, PubMed, and EMBASE databases for studies evaluating the influence of RVAP on LVEF. Pooled mean difference (MD) with a 95% confidence interval (CI) was estimated using a random effect model. RESULTS: 14 randomized controlled trials (RCTs) comprising 885 patients were included. In our meta-analysis, RVAP was associated with statistically significant left ventricular systolic function impairment as measured by LVEF. The mean difference between LVEF at baseline and after intervention amounted to 3.35% (95% CI: 1.80-4.91). CONCLUSION: our meta-analysis confirms that right ventricular apical pacing is associated with progressive deterioration of left ventricular systolic function.