Key result
Permanent pacemaker implantation in congenital complete heart block carries a ~13% incidence of PICM.
Why the study?
The long-term burden of pacing-induced cardiomyopathy, mortality, and device-related complications after permanent pacemaker implantation in patients with congenital complete atrioventricular block has not been quantitatively synthesized.
Meta-Analysis (n=1,233)
Permanent pacemaker implantation in patients with congenital complete atrioventricular block carries a clinically meaningful lifetime burden of pacing-induced cardiomyopathy, mortality, and device complications.
Answers are grounded in this paper and cite their sources.
Warrants long-term LV surveillance after pacing in congenital AV block; extends incidence estimates and leaves open optimal prevention strategies.
BACKGROUND Congenital complete atrioventricular block (CCAVB) requires pacing from early life, yet the long-term burden of pacing-induced cardiomyopathy (PICM), mortality, and device-related complications has not been quantitatively synthesized. OBJECTIVE To determine the incidence of PICM, mortality, and device-related complications after permanent pacemaker implantation in patients with CCAVB. METHODS PubMed, Scopus, and Web of Science were searched from inception through February 2026. Longitudinal studies enrolling patients with isolated or predominantly isolated CCAVB undergoing permanent pacemaker implantation, reporting PICM or left ventricular (LV) dysfunction, and with ≥6 months' follow-up were included. PICM was defined as LV ejection fraction < 50% or study-specific LV dysfunction. Pooled event rates were estimated using random-effect meta-analysis. RESULTS Eighteen studies including 1,233 paced patients were included. The pooled incidence of PICM was 13.3% (95% CI 9.9-17.7%; I2=68%). Sensitivity analyses across alternative definitions yielded similar estimates (12.1% to 13.4%). PICM onset occurred earlier in antibody-positive than non-immune populations (mean 1.9 vs. 17.4 years; p=0.009). All-cause mortality was 6.3% (95% CI 3.8-10.3%; I2=75%), lead failure 9.5% (95% CI 4.2-19.9%; I2=85%), and device infection 8.2% (95% CI 4.4-15.0%; I2=49%), including 4.2% deep/device-related infection (95% CI 2.1-8.2%; I2=20%). Longer follow-up showed a non-significant trend toward higher PICM incidence (β=+0.025 per year; p=0.080). CONCLUSION In CCAVB, permanent pacing is associated with a clinically meaningful, lifelong burden of cardiomyopathy, mortality, and device-related complications. The wide variation in outcome definitions and the largely retrospective evidence base limit firm conclusions, underscoring the need for prospective multicentre studies with standardized definitions.
No takes yet. Share an insight, caveat, or question.
Vlachakis et al. (2026) conducted a meta-analysis in Congenital complete atrioventricular block (CCAVB) (n=1,233). Permanent pacemaker implantation was evaluated on Incidence of pacing-induced cardiomyopathy (PICM) (95% CI 9.9-17.7). Permanent pacemaker implantation in patients with congenital complete atrioventricular block was associated with a 13.3% pooled incidence of pacing-induced cardiomyopathy (95% CI 9.9-17.7%).
Synapse has enriched 10 related papers. Consider them for comparative context: