Clinical factors associated with health-related quality of life following permanent pacemaker implantation: a multicenter cross-sectional study

Background: Permanent pacemaker implantation (PPI) is an established treatment for symptomatic bradyarrhythmias, but determinants of health-related quality of life (QoL) remain incompletely understood, particularly in middle-income settings. Objectives: To identify clinical and demographic factors associated with QoL among permanent pacemaker recipients, with emphasis on LVEF, ventricular pacing burden, and rate-responsive pacing. Methods: In this multicenter cross-sectional study, 492 adults with a permanent pacemaker implanted at least 6 months earlier were enrolled at tertiary cardiology centers in Georgia between January 2025 and January 2026. QoL was assessed using the SF-36. Associations with physical functioning were evaluated using multivariable linear regression. Results: Mean age was 65.4±11.8 years and 63.4% were male. Physical functioning was among the lowest-scoring SF-36 domains. Older age (B= −0.621; P<0.001), comorbidity (B= −7.921; P<0.001), and longer implantation duration (B= −0.271; P=0.028) were associated with lower physical functioning. Male sex (B=6.845; P<0.001), higher LVEF (B=0.542; P<0.001), and active rate-responsive pacing (B=4.120; P=0.008) were associated with higher scores. Ventricular pacing burden was not independently associated with physical functioning (B= −0.032; P=0.254). Conclusions: Physical functioning was among the lowest-scoring QoL domains. Age, sex, comorbidity, LVEF, implantation duration, and rate-responsive pacing were independently associated with physical functioning, whereas ventricular pacing burden was not.