Complete atrioventricular block in pacemaker patients increased new-onset heart failure risk in acute (HR 1.62; P<0.001) and chronic (HR 1.16; P<0.001) phases compared to those without AVB.
Cohort (n=21,202)
Yes
Does dual-chamber pacemaker implantation for complete atrioventricular block increase the risk of new-onset heart failure compared to implantation without AV block?
Patients with complete AV block undergoing dual-chamber pacemaker implantation have a significantly higher risk of developing new-onset heart failure, particularly in the first 6 months, compared to those without AV block.
Effect estimate: HR 1.62 (95% CI 1.48-1.79)
p-value: p=<0.001
Background— Although right ventricular pacing can contribute to cardiomyopathy, the impact of complete atrioventricular block (cAVB) on heart failure (HF) development in pacemaker patients has not been well characterized. We evaluated the incidence and time course for developing HF after pacemaker implantation for cAVB. Methods and Results— A MarketScan database identified patients undergoing dual-chamber pacemaker implantation from 2008 to 2014. Patients with cAVB were identified by an atrioventricular node ablation or diagnosis of third-degree AVB. Patients with ≥1 year of continuous MarketScan enrollment before and after implant and without a previous diagnosis of HF were dichotomized into those with cAVB and without AVB. The primary end point was new HF assessed over acute (0–6 months) and chronic (6 months to 4 years) phases post–pacemaker implantation. The cohort included 6994 cAVB patients and 14 208 patients without AVB, followed for 2.35 years (interquartile range, 1.62–3.39 years). After adjustment for baseline covariates, patients with cAVB experienced an increased risk of new-onset HF in the acute phase (hazard ratio, 1.62; 95% confidence interval, 1.48–1.79; P <0.001). Although the risk of HF remained elevated among those with cAVB in the chronic phase, the effect was attenuated (hazard ratio, 1.16; 95% confidence interval, 1.08–1.25; P <0.001). After pacemaker implantation, younger patients (≤55 years of age) and those with an antecedent history of atrial fibrillation experienced the highest risk of HF associated with cAVB. Conclusions— Patients with a diagnosis of cAVB, and thus presumed to have a higher burden of right ventricular pacing, experienced an increased risk of new-onset HF after pacemaker implantation compared with those without AVB. Better tools are needed to identify patients at high risk of developing HF in the setting of right ventricular pacing and to determine whether these patients benefit from upfront biventricular pacing.
Merchant et al. (Thu,) conducted a cohort in Complete atrioventricular block (n=21,202). Complete atrioventricular block (presumed high-burden right ventricular pacing) vs. No atrioventricular block was evaluated on New heart failure assessed over acute (0-6 months) and chronic (6 months to 4 years) phases post-pacemaker implantation (HR 1.62, 95% CI 1.48-1.79, p=<0.001). Complete atrioventricular block in pacemaker patients increased new-onset heart failure risk in acute (HR 1.62; P<0.001) and chronic (HR 1.16; P<0.001) phases compared to those without AVB.