Key result
High-degree AV block linked to ~5.7-fold higher odds of RVP dependence.
Why the study?
Right ventricular pacing dependence can impair left ventricular ejection fraction, but the relationship between pacing proportion, ejection fraction, and predictors of dependence needed illumination.
Does right ventricular pacing dependence (>80%) impair cardiac function, and what baseline factors independently predict the development of pacing dependence?
Case-Control (n=1,183)
Does right ventricular pacing dependence (>80%) impair cardiac function, and what baseline factors independently predict the development of pacing dependence?
Odds Ratio: 5.71 (95% CI 3.66–8.85)
p-value: p=<0.0001
Clinical and electrocardiographic factors like advanced AV block, prolonged QRS/QTc, and atrial fibrillation can predict right ventricular pacing dependence, which drives adverse remodeling and LV dysfunction.
High-degree AV block may flag patients for closer LVEF surveillance post-pacemaker; leaves open whether physiologic pacing alters outcomes in case-control data.
Aims Right ventricular pacing (RVP) dependence could impair left ventricular ejection fraction (LVEF). This study aimed to illuminate the relationship between RVP proportion and LVEF, as well as disclosing independent predictors of RVP dependence. Methods and results Patients indicated for permanent pacemaker implantation were included (2016–2020). The ventricular pacing lead was placed in right ventricular apex or septum. Pacing mode programming followed universal standard. Electrocardiographic, echocardiographic, and serological parameters were collected. RVP dependence was defined according to its influence on LVEF. This study was of case–control design. Included patients were matched by potentially confounding factors through propensity score matching. A total of 1183 patients were included, and the mean duration of follow-up was 24 months. Percentage of RVP < 80% hardly influenced LVEF; however, LVEF tended to decrease with higher RVP proportion. High degree/complete atrioventricular block (AVB) [odds ratio (OR) = 5.71, 95% confidence interval (CI): 3.66–8.85], atrial fibrillation (AF) (OR = 2.04, 95% CI: 1.47–2.82), percutaneous coronary intervention (PCI) (OR = 2.89, 95% CI: 1.24–6.76), maximum heart rate (HRmax) < 110 b.p.m. (OR = 2.74, 95% CI: 1.58–4.76), QRS duration > 120 ms (OR = 2.46, 95% CI: 1.42–4.27), QTc interval > 470 ms (OR = 2.01, 95% CI: 1.33–3.05), and pulmonary artery systolic pressure (PASP) > 40 mmHg (OR = 1.93, 95% CI: 1.46–2.56) were proved to predict RVP dependence. Conclusions High RVP percentage (>80%) indicating RVP dependence significantly correlates with poor prognosis of cardiac function. High degree/complete AVB, AF, ischaemic aetiology, PCI history, HRmax < 110 b.p.m., QRS duration > 120 ms, QTc interval > 470 ms, and PASP > 40 mmHg were verified as independent risk factors of RVP dependence.
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Yu et al. (2022) conducted a case-control in Patients indicated for permanent pacemaker implantation (n=1,183). High degree/complete atrioventricular block (AVB) vs. Absence of high degree/complete AVB was evaluated on Right ventricular pacing (RVP) dependence (>80% RVP proportion) (OR 5.71, 95% CI 3.66-8.85, p=<0.0001). High degree/complete atrioventricular block strongly predicted the development of right ventricular pacing dependence (>80% pacing burden) with an OR of 5.71, which significantly correlated with diminished left ventricular ejection fraction.
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