Key result
Cardiomyopathy-associated genetic variations were identified in 100% of patients who developed newly-onset heart failure after right ventricular apical pacing, compared to 30% of matched controls.
Why the study?
Do cardiomyopathy-associated genetic variations contribute to the development of heart failure in patients with third-degree atrioventricular block undergoing right ventricular apical pacing?
Observational (n=877)
No
Do cardiomyopathy-associated genetic variations contribute to the development of heart failure in patients with third-degree atrioventricular block undergoing right ventricular apical pacing?
Cardiomyopathy-associated genetic variations, such as Lamin A/C mutations, predispose patients with third-degree AV block to develop heart failure when subjected to the extra stress of right ventricular apical pacing.
Answers are grounded in this paper and cite their sources.
Should not yet change pacing decisions; leaves open genetic predisposition to RVA pacing-induced HF.
Right ventricular apical (RVA) pacing can lead to progressive left ventricular dysfunction and heart failure (HF), even in patients with normal cardiac structure and function. Our study conducted candidate gene screening and lentivirus transfected neonatal rat cardiomyocytes (NRCMs) to explore the genetic and pathogenic mechanisms of RVA pacing induced cardiomyopathy in third degree atrioventricular block (III AVB) patients. We followed 887 III AVB patients with baseline normal cardiac function and RVA pacing. After a median follow-up of 2.5 years, 10 patients (four males, mean age 47.6 ± 10.0 years) were diagnosed with RVA pacing induced HF with left ventricular ejection fraction (LVEF) reducing dramatically to 37.8 ± 7.1% (P < 0.05). Candidate genes sequencing found cardiomyopathy associated genetic variations in all ten HF patients and six SCN5A variations in 6 of 20 control patients. Transfected NRCMs of Lamin A/C mutations (R216C and L379F) disrupted Lamin A/C location on nucleus membrane and finally resulted in increased apoptotic rate after serum starvation. In conclusion, cardiomyopathy associated genetic variations play an essential role in occurrence of newly onset HF in the III AVB patients with RVA pacing. RVA pacing, serving as extra stimulator, might accelerate the deterioration of cardiac structure and function.
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Liu et al. (2017) conducted an observational in Third-degree atrioventricular block (III AVB) with right ventricular apical (RVA) pacing (n=877). Cardiomyopathy-associated genetic variations vs. Matched controls without heart failure was evaluated on Presence of cardiomyopathy-associated genetic variations. Cardiomyopathy-associated genetic variations were identified in 100% of patients who developed newly-onset heart failure after right ventricular apical pacing, compared to 30% of matched controls.
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