Clinical & Experimental Cardiology
Open Access
ISSN: 2155-9880
+44 1300 500008
ISSN: 2155-9880
+44 1300 500008
Pacing Induced Cardiomyopathy (PICM) can be a significant problem with long term right ventricular pacing, especially from the apex. It is unclear if PICM may be minimized by standard pacing of the Right Ventricle (RV) at sites other than the RVA. The purpose of our recent study was to compare the relative frequency of PICM in a population of patients paced at either the superficial RV Mid Septum (RVMS) or RV Apex (RVA) and other outcomes that may differ between these sites.
A retrospective evaluation was performed on all patients undergoing pacemaker implantation between 2011 and 2022. Potential study patients were those with Medtronic 3830 superficial RVMS leads placed with a septal specific guidance catheter and any with RVA leads. Patients were included if they had >20% RV pacing, available baseline and follow-up measurements of Left Ventricular Ejection Fraction (LVEF) at least 6 months post implantation and a baseline LVEF>50%. PICM was defined as a decline in the LVEF of at least 10%, resulting in LVEF<50%. Patients were excluded for biventricular devices and for alternative causes of cardiomyopathy.
The study criteria were met in 220 RVMS and 104 RVA paced patients. PICM occurred in 4.5% of RVMS patients and 22.1% of RVA patients (p<0.001). Additionally, the paced QRS duration was significantly shorter in the RVMS group (144+15.5 msec in RVMS, 166+19.4 msec in RVA; p<0.001) and the QRS axis was more normal (2.3+64.9 in RVMS, -65.2+49.5 in RVA; p<0.001).
Patients with normal LVEF experienced significantly less PICM with superficial RVMS pacing performed via septal specific guidance catheters than similar counterparts with RVA pacing. Narrower paced QRS duration and less left axis deviation was also demonstrated.
Published Date: 2024-12-16; Received Date: 2024-11-15