Key result
High ventricular pacing burden is linked to significantly more cardiac events versus low pacing.
Why the study?
The impact of septal versus apical right ventricular pacing on clinical outcomes in patients with high ventricular pacing percentages was unclear.
Does a high percentage of ventricular pacing (>90%) increase the risk of cardiac events compared to a low percentage (<10%) in patients with newly implanted permanent pacemakers?
Cohort (n=256)
No
Does a high percentage of ventricular pacing (>90%) increase the risk of cardiac events compared to a low percentage (<10%) in patients with newly implanted permanent pacemakers?
p-value: p=0.002
A high burden of ventricular pacing (>90%) is associated with an increased risk of cardiac death or heart failure hospitalization, with risk further driven by older age, lower ejection fraction, and longer paced QRS duration, whereas pacing site did not significantly impact prognosis.
High ventricular pacing burden may elevate event risk; leaves open whether minimization strategies improve outcomes in observational cohorts.
Previous reports have suggested that right ventricular apical pacing may lead to cardiac dysfunction. Septal pacing is thought to be superior to apical pacing in the prevention of cardiac dyssynchrony, however, there have been no reports on the contribution of septal pacing to improving clinical outcome.We retrospectively evaluated factors associated with cardiac events in patients with right ventricular pacing.The study population consisted of 256 consecutive patients newly implanted with permanent pacemakers and followed-up for 29 ± 18 months. Cardiac events, consisting of cardiac death or heart failure requiring hospitalization, occurred in 22 patients. Kaplan-Meier curves revealed that patients with a high percentage of ventricular pacing (> 90%, n = 101, group H) had a higher incidence of cardiac events than patients with a low percentage of ventricular pacing (< 10%, n = 83, group L) (P = 0.002). In group H, multivariate analysis showed that age (HR: 1.174, 95%CI: 1.066-1.291, P = 0.001), ejection fraction (EF) (HR: 0.898, 95%CI: 0.836-0.964, P = 0.003), QRS duration during cardiac pacing (HR: 1.059, 95%CI: 1.017-1.103, P = 0.006), and existing basal cardiac diseases (HR: 13.080, 95%CI: 2.463-69.479, P = 0.003) were significant predictors of cardiac events, although pacing site had no significant association with prognosis (P = 0.56).Higher age, lower EF, longer QRS duration during cardiac pacing, and existing basal cardiac diseases are associated with poor prognosis in patients with a high percentage of ventricular pacing.
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Sakatani et al. (2015) conducted a cohort in Patients newly implanted with permanent pacemakers (n=256). High percentage of ventricular pacing (> 90%) vs. Low percentage of ventricular pacing (< 10%) was evaluated on Cardiac events (cardiac death or heart failure requiring hospitalization) (p=0.002). Patients with a high percentage of ventricular pacing (>90%) had a significantly higher incidence of cardiac events than those with low pacing (<10%), with age, lower ejection fraction, longer QRS duration, and basal cardiac diseases predicting poor prognosis.
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