A high right ventricular pacing burden (≥ 40%) did not significantly alter echocardiographic parameters, including left ventricular ejection fraction, or spiroergometric exercise capacity over 12 to 24 months in pacemaker patients with preserved left ventricular function.
Observational (n=108)
Single-blind
No
Does a high right ventricular pacing burden reduce echocardiographic and spiroergometric parameters in pacemaker patients with preserved left ventricular ejection fraction?
In patients with preserved LVEF, a high right ventricular pacing burden (≥40%) does not significantly worsen echocardiographic or spiroergometric parameters over a 12- to 24-month follow-up compared to a low pacing burden.
Absolute Event Rate: 58.8% vs 57.6%
BACKGROUND: The incidence of worsened clinical outcome due to high right ventricular (RV) pacing burden in patients with preserved left ventricular function remains controversial. OBJECTIVE: To investigate the impact of RV pacing on several echocardiographic and spiroergometric parameters. METHODS: In 60 pacemaker patients with preserved left ventricular ejection fraction (LVEF) serial echocardiographies and spiroergometries were performed over a time course of 12 months. Additionally, in 48 patients retrospective echocardiographic analyses of the LV- and RV function were carried out up to 24 months after pacemaker implantation. RESULTS: The patients were divided into two groups: The high RV pacing burden group (hRVP: ≥ 40%) and the low RV pacing group (lRVP < 40%) according to the definitions in previous randomized MOST and DAVID trials. After a period of 12-month pacemaker therapy no changes to left ventricular end diastolic diameter (LVEDD), left ventricular end systolic diameter (LVESD), LVEF, E/A-ratio; E/E'-ratio and tricuspid annular plane systolic excursion (TAPSE) could be revealed, independently of the RV pacing burden. Additionally, after 24-month long term follow-up there were no differences in LVEF and TAPSE in both groups. Accordingly, no relevant changes of peak exercise capacity, ventilatory anaerobic threshold or maximal oxygen consumption could be demonstrated independently of the RV pacing. CONCLUSIONS: In pacemaker patients with preserved LVEF the burden of RV pacing has no adverse influence on several echocardiographic and spiroergometric surrogate parameters of pacemaker-induced cardiomyopathy after a follow-up of 12 to 24 month. Despite this, screening for pacemaker induced cardiomyopathy should be performed especially in the presence of new heart failure symptoms.
Youssef et al. (Mon,) conducted a observational in Pacemaker indication with preserved left ventricular ejection fraction (n=108). High right ventricular pacing burden (≥ 40%) vs. Low right ventricular pacing burden (< 40%) was evaluated on Left ventricular ejection fraction (LVEF) at 12 months. A high right ventricular pacing burden (≥ 40%) did not significantly alter echocardiographic parameters, including left ventricular ejection fraction, or spiroergometric exercise capacity over 12 to 24 months in pacemaker patients with preserved left ventricular function.