Serial GLS assessments over time in patients with preserved ejection fraction undergoing permanent cardiac pacemaker placement

Abstract Background Chronic right-ventricular (RV) pacing can exacerbate heart failure in patients with a low ejection fraction (EF), but little is known about pacing-induced cardiomyopathy (PICM) in patients with preserved EF. We aimed to investigate risk factors of PICM in these patients during long-term follow-up. Methods The prospective registry at our University Hospital, South Korea, included de novo patients with preserved EF undergoing transvenous permanent pacemaker (PPM) implantation for atrioventricular blockage from 2018 to 2022. Patients with EF 50% and expected ventricular pacing 40% were included. All patients were followed with serial echocardiography (preimplant, post implant, 12 months). All patients enrolled in this study were seen as outpatients every 3–6 months. Composite outcomes were cardiac death (pump failure), hospitalization because of heart failure, PICM, and biventricular pacing (BVP) upgrade. Results 71 patients (28 men, 73.1 ± 9.5 years) were included. After PPM implantation, EF and GLS were significantly decreased. During three years of follow-up, 2 patient died, 6 were hospitalized, 7 suffered PICM, and 3 underwent BVP upgrade. Cox regression analysis identified reduced post-implant global longitudinal strain (GLS) (HR, 1.524; 95% CI, 1.149–2.021; P = 0.003) as independent predictors of PICM. Post-implant GLS showed high predictive accuracy for PICM, with an area under the curve of 0.92 (95% CI 0.829–0.971; P 0.001) Conclusion Post-implant GLS, rather than pre-implant GLS could help identify individuals at high risk of PICM. After PPM implantation, it is important to measure GLS, and patients with reduced GLS should be monitored more frequently and echocardiographic surveillance, with a view to an upgrade to BVP.Serial EF and GLS assessmentGLS ROC curve