Key result
An ECG voltage-time-integral ≥ 80 μVs can screen for pacing-induced cardiomyopathy, while an RV-paced QRS duration >180 ms identifies patients who may not respond to CRT upgrade.
Why the study?
Chronic right ventricular pacing causes pacing-induced cardiomyopathy in only a small number of patients, motivating evaluation of ECG correlates of PICM and response to CRT upgrade.
Do specific electrocardiographic parameters predict pacing-induced cardiomyopathy and response to CRT upgrade in patients with chronic right ventricular pacing?
Case-Control
No
Do specific electrocardiographic parameters predict pacing-induced cardiomyopathy and response to CRT upgrade in patients with chronic right ventricular pacing?
Specific ECG parameters, such as QRS voltage-time-integral and QRS duration, can help screen for pacing-induced cardiomyopathy and predict non-response to CRT upgrade.
QTc and QRS duration may aid PICM risk identification and CRT response prediction; leaves open prospective validation before guiding upgrades.
BACKGROUND: Chronic right ventricular (RV) pacing (RVP) causes pacing-induced cardiomyopathy (PICM) in only a small number of patients. We evaluated ECG correlates of (i) PICM and (ii) response to cardiac resynchronization therapy (CRT) upgrade. METHODS: We conducted a retrospective case-control study by including all CRT upgrades for PICM (LVEF <50%) at our center between 2014 and 2018. Controls were patients with ≥5 ECGs all demonstrating RVP over ≥2 years and all echocardiographic LVEF ≥50%. Root-summed-squared (3D) ECG was obtained from reconstructed vectorcardiographic X-Y-Z leads. Predictors of PICM and CRT response were assessed as area under ROC curve (AUC) for pre-CRT and Δ (post-CRT - pre-CRT) ECG intervals and QRS voltage-time-integrals (VTI). RESULTS: (0.608). CONCLUSION: ≥ 80 μVs can be used as a screening test for echocardiographic confirmation of PICM. RV-paced QRS duration >180 ms, on the other hand, identifies those who may not respond to CRT upgrade.
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Gupta et al. (2026) conducted a case-control in Pacing-induced cardiomyopathy. ECG parameters (QRS duration and voltage-time-integrals) vs. Controls with LVEF ≥50% was evaluated on Predictors of PICM and CRT response (AUC for pre-CRT and Δ ECG intervals and QRS VTI). An ECG voltage-time-integral ≥ 80 μVs can screen for pacing-induced cardiomyopathy, while an RV-paced QRS duration >180 ms identifies patients who may not respond to CRT upgrade.
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