Key result
High right ventricular pacing (≥10%) in ICD patients was associated with significantly higher rates of appropriate shocks (35% vs. 10%; OR 2.99, p=0.01) and death compared to low pacing (<10%).
Why the study?
Although RV pacing is linked to cardiomyopathy, hospitalization, and death in ICD patients, its association with ventricular tachyarrhythmias is poorly understood.
Does ≥10% right ventricular pacing increase the incidence of appropriate ICD shocks and death in patients with de novo ICD insertion?
Cohort (n=178)
No
Does ≥10% right ventricular pacing increase the incidence of appropriate ICD shocks and death in patients with de novo ICD insertion?
Odds Ratio: 2.99
Absolute Event Rate: 35% vs 10%
p-value: p=0.01
High right ventricular pacing burden (≥10%) in ICD patients is associated with a significantly increased risk of appropriate shocks for ventricular tachyarrhythmias and higher mortality.
BACKGROUND: Right ventricular (RV) pacing has been associated with increased risk of pacemaker-induced cardiomyopathy, hospitalization and death among patients with implantable cardioverter defibrillators (ICDs). Little is known about its association with ventricular tachyarrhythmias. We hypothesize that RV pacing is associated with increased incidence of appropriate ICD shocks and death. METHODS: Retrospective study of consecutive patients with de novo ICD insertion (excluding cardiac resynchronization therapy devices) from a single tertiary care center. Patients were classified into <10% RV pacing (low-pace group) and ≥10% RV pacing (high-pace group). Data were compared using two-tailed t tests and Fisher's exact test. Binomial logistic regression was performed to identify predictors of appropriate ICD therapies. RESULTS: A total of 178 patients (54 high paced and 124 low paced) were included. Mean follow-up was 43 ± 11 months. Appropriate shocks occurred in 27 patients (15%) and were significantly higher in the high-pace group (35% vs. 10%, p = 0.008), as the number of deaths (31% vs. 11%, p = 0.001). Binary logistic regression showed a significantly increased risk of shock (OR 2.99, p = 0.01) and death (OR 3.61, p = 0.002) in high-paced patients. Multivariable analysis showed no difference in risk of shocks based on age, sex or ejection fraction. Older patients had higher risk of death. CONCLUSIONS: In this population of ICD patients, those with a high prevalence of RV pacing experienced more shocks for VF/VT and had higher mortality. Further studies should be done to determine whether minimizing RV pacing reduces arrhythmias, shock burden and death in patients with ICDs.
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Arcinas et al. (2019) conducted a cohort in Patients with de novo implantable cardioverter defibrillator (ICD) insertion (n=178). ≥10% right ventricular pacing (high-pace group) vs. <10% right ventricular pacing (low-pace group) was evaluated on Appropriate ICD shocks (OR 2.99, p=0.01). High right ventricular pacing (≥10%) in ICD patients was associated with significantly higher rates of appropriate shocks (35% vs. 10%; OR 2.99, p=0.01) and death compared to low pacing (<10%).
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