Predictors of left ventricular dysfunction with right ventricular pacing: Is paced QRS duration the answer?

Q: What is the clinical evidence from this study?

Study design: Editorial. Population: Left ventricular dysfunction associated with right ventricular pacing. Intervention: Right ventricular pacing (and paced QRS duration / pacing site optimization). Primary outcome: Left ventricular dysfunction and congestive heart failure.

Una Buckley; Kalyanam Shivkumar

doi:10.1016/j.ipej.2015.07.002

March 1, 2015Indian Pacing and Electrophysiology JournalOpen Access

Predictors of left ventricular dysfunction with right ventricular pacing: Is paced QRS duration the answer?

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Key result

Paced QRS duration (with cut-offs around 190–200 ms) and non-apical pacing sites may predict left ventricular dysfunction in right ventricular pacing, though prospective RCTs are needed.

Why the study?

Does paced QRS duration or alternative right ventricular pacing site predict left ventricular dysfunction in patients with permanent pacemakers?

Key Points

To assess whether paced QRS duration and specific device programming strategies can predict or mitigate left ventricular dysfunction in patients receiving right ventricular pacing.
Expert editorial reviewing clinical evidence on paced QRS duration and pacing site selection in patients with permanent pacemakers.
Synthesized findings from randomized trials and observational studies addressing lead placement, atrioventricular delay programming, and pacing thresholds.
A paced QRS duration cutoff of approximately 190–200 ms correlates with left ventricular dysfunction and heart failure in small non-randomized studies.
Non-apical right ventricular pacing positions show benefit in patients with impaired left ventricular function (<45%) based on an analysis of 14 randomized controlled trials (N=754), but demonstrate no difference in those with normal baseline ejection fraction.
Approximately 25% of patients receiving right ventricular pacing for sick sinus syndrome and complete heart block experience pacemaker syndrome.

Structured PICO

Does paced QRS duration or alternative right ventricular pacing site predict left ventricular dysfunction in patients with permanent pacemakers?

P

Population

Patients with permanent pacemakers receiving right ventricular pacing (e.g., for sick sinus syndrome or complete heart block)

I

Intervention

Right ventricular pacing (evaluating paced QRS duration, RVOT/septal/His bundle pacing sites, and device programming optimization)

O

Outcome

Progression of left ventricular dysfunction and congestive heart failure

Limitations

Estimates for paced QRS duration cut-offs (190-200 ms) are derived from small non-randomized trials.
Operators may incorrectly identify an RV free wall lead position as septal.
Correlation between paced QRS duration, LV function, and mechanical dyssynchrony remains unclear.
Referenced studies lack detail on how asymptomatic atrial fibrillation and device mode-switching were assessed.
Lack of long-term clinical outcome data for upfront CRT in patients with heart failure and pacemaker indications.
Cut-off values for paced QRS duration (190–200 ms) are based on small non-randomized trials
Operators may misidentify RV lead position as septal when it is actually free wall
Unclear correlation between paced QRS duration, LV function, and mechanical dyssynchrony
Incomplete assessment of asymptomatic new-onset atrial fibrillation and device mode switching in referenced studies
Lack of long-term data on clinical outcomes for upfront cardiac resynchronization therapy

Implication

This editorial highlights that while paced QRS duration and non-apical RV pacing sites may help predict pacing-induced LV dysfunction, larger prospective RCTs with detailed device programming data are needed to guide optimal device selection.

Abstract

Predictors of left ventricular dysfunction with right ventricular pacing: Is paced QRS duration the answer?* * This Editorial refers to: Paced QRS duration predicts left ventricular function in patients with permanent pacemakers eOneyear follow-up study using equilibrium radionuclide angiography (ERNA).Peer review under responsibility of Indian Heart Rhythm Society.

Discussion

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Cite This Study

Buckley et al. (2015) conducted an editorial in Left ventricular dysfunction associated with right ventricular pacing. Right ventricular pacing (and paced QRS duration / pacing site optimization) was evaluated on Left ventricular dysfunction and congestive heart failure. Paced QRS duration (with cut-offs around 190–200 ms) and non-apical pacing sites may predict left ventricular dysfunction in right ventricular pacing, though prospective RCTs are needed.

synapsesocial.com/papers/6a73783d4e58671dcf6c35f9 https://doi.org/10.1016/j.ipej.2015.07.002

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Predictors of left ventricular dysfunction with right ventricular pacing: Is paced QRS duration the answer?

Key Points

Structured PICO

Limitations

Implication

Abstract

Discussion

Cite This Study

Predictors of left ventricular dysfunction with right ventricular pacing: Is paced QRS duration the answer?

Key Points

Structured PICO

Limitations

Implication

Abstract

Discussion

Cite This Study

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