Paced QRS Duration as the Major Determinant of Pacing Induced Cardiomyopathy in Complete AV Block
Induced Cardiomyopathy in Atrioventricular Block
DOI:
https://doi.org/10.54393/pjhs.v5i09.2058Keywords:
Atrioventricular Block, Permanent Pacemaker, Pacing Induced CardiomyopathyAbstract
Patients with complete heart block often develop pacing-induced cardiomyopathy (PICM) after placement of a permanent pacemaker. Objective: To establish paced QRS duration as determinant of pacing induced cardiomyopathy in complete Atrioventricular (AV) block. Methods: This descriptive study included 115 male and female patients that had a permanent pacemaker implanted for complete AV block, at the department of Cardiology, Hayatabad Medical Complex, Peshawar, during the period 1st November 2023 till 30th June 2024. Patients were evaluated for the presence of PICM and subsequently grouped as PICM and non-PICM. Paced QRS duration in both groups was compared. Results: PICM was confirmed in 63 patients (54.8%) and 52 (45.2%) were non-PICM. Mean age in PICM group was 71.2 ± 8.7 years and 66.8 ± 9.5 years in non-PICM group. The mean paced QRS duration in PICM group was 200.5 ± 22.3 milliseconds and 168.3 ± 15.7milliseconds in non-PICM group (p value <0.001). Conclusion: Prolonged paced QRS duration was found as key indicator for predicting pacing induced cardiomyopathy in patients with permanent pacing for complete AV block.
References
Kiehl EL, Makki T, Kumar R, Gumber D, Kwon DH, Rickard JW et al. Incidence and predictors of right ventricular pacing-induced cardiomyopathy in patients with complete atrioventricular block and preserved left ventricular systolic function. Heart Rhythm. 2016 Dec; 13(12): 2272-8. doi: 10.1016/j.hrthm.2016.09.027.
Gavaghan C. Pacemaker induced cardiomyopathy: an overview of current literature. Current Cardiology Reviews. 2022 May; 18(3). doi: 10.2174/2772432816666210901111616.
Kotecha D and Piccini JP. Atrial fibrillation in heart failure: what should we do?. European Heart Journal. 2015 Dec; 36(46): 3250-7. doi: 10.1093/eurheartj/ehv513.
Babu NS, Srinath SC, Lahiri A, Chase D, John B, Roshan J. Three-dimensional echocardiography with left ventricular strain analyses helps earlier prediction of right ventricular pacing-induced cardiomyopathy. Journal of the Saudi Heart Association. 2018 Apr; 30(2): 102-7. doi: 10.1016/j.jsha.2017.06.001.
Khurshid S, Obeng-Gyimah E, Supple GE, Schaller R, Lin D, Owens AT et al. Reversal of pacing-induced cardiomyopathy following cardiac resynchronization therapy. JACC: Clinical Electrophysiology. 2018 Feb; 4(2): 168-77. doi: 10.1016/j.jacep.2017.10.002.
Khurwolah MR, Yao J, Kong XQ. Adverse consequences of right ventricular apical pacing and novel strategies to optimize left ventricular systolic and diastolic function. Current Cardiology Reviews. 2019 May; 15(2): 145-55. doi: 10.2174/1573403X15666181129161839.
Stanley Jr A, Athanasuleas C, Buckberg G. How his bundle pacing prevents and reverses heart failure induced by right ventricular pacing. Heart Failure Reviews. 2021 Nov; 26(6): 1311-24. doi: 10.1007/s10741-020-09962-8.
Al Younis SM, Hadjileontiadis LJ, Al Shehhi AM, Stefanini C, Alkhodari M, Soulaidopoulos S et al. Investigating automated regression models for estimating left ventricular ejection fraction levels in heart failure patients using circadian ECG features. PLOS One. 2023 Dec; 18(12): e0295653. doi: 10.1371/journal.pone.0295653.
Al-Asad KS, Martinez A, Prasad RM, Ukponmwan EU, Baloch ZQ, Ali A et al. Pacing-Induced Cardiomyopathy in Leadless and Traditional Pacemakers: A Single-Center Retrospective Analysis. Cureus. 2023 Jul; 15(7): e41393. doi: 10.7759/cureus.41393.
Medina-Ravell VA, Lankipalli RS, Yan GX, Antzelevitch C, Medina-Malpica NA, Medina-Malpica OA et al. Effect of epicardial or biventricular pacing to prolong QT interval and increase transmural dispersion of repolarization: does resynchronization therapy pose a risk for patients predisposed to long QT or torsade de pointes?. Circulation. 2003 Feb; 107(5): 740-6. doi: 10.1161/01.CIR.0000048126.07819.37.
Zhang J, Ju W, Yang G, Tang C, Luo J, Xu J et al. Epicardial ablation of refractory focal atrial tachycardia after a failed endocardial approach. Heart Rhythm. 2023 Mar; 20(3): 374-82. doi: 10.1016/j.hrthm.2022.11.007.
Ghosh A, Kapoor A, Khanna R, Sahu A, Kumar S, Garg N et al. A pilot study on the acute conversion and maintenance of sinus rhythm in rheumatic atrial fibrillation using oral flecainide. Indian Heart Journal. 2020 Sep; 72(5): 383-8. doi.org/10.1016/j.ihj.2020.07.004.
Emerek K, Friedman DJ, Sørensen PL, Hansen SM, Larsen JM, Risum N et al. Vectorcardiographic QRS area is associated with long-term outcome after cardiac resynchronization therapy. Heart Rhythm. 2019 Feb; 16(2): 213-9. doi: 10.1016/j.hrthm.2018.08.028.
Caleyachetty R, Littlejohns T, Lacey B, Bešević J, Conroy M, Collins R et al. United Kingdom Biobank (UK Biobank) JACC Focus Seminar 6/8. Journal of the American College of Cardiology. 2021 Jul; 78(1): 56-65. doi: 10.1016/j.jacc.2021.03.342.
Fruelund PZ. Chronic effects of right ventricular pacing: The impact of right ventricular lead position. 2024 Sep. doi: 10.54337/aau534290121.
Iaccarino G, Ciccarelli M, Sorriento D, Galasso G, Campanile A, Santulli G et al. Ischemic neoangiogenesis enhanced by β2-adrenergic receptor overexpression: a novel role for the endothelial adrenergic system. Circulation Research. 2005 Nov; 97(11): 1182-9. doi: 10.1161/01.RES.0000191541.06788.bb.
Weintraub WS and Boden WE. Deferral of PCI, a safe strategy in diabetic patients with chronic coronary syndromes. Heart. 2020 Nov; 106(21): 1627-8. doi: 10.1136/heartjnl-2020-317363.
Samaras K, Makkar SR, Crawford JD, Kochan NA, Slavin MJ, Wen W et al. Effects of statins on memory, cognition, and brain volume in the elderly. Journal of the American College of Cardiology. 2019 Nov; 74(21): 2554-68. doi: 10.1016/j.jacc.2019.09.041.
Garcia, J. M., Fernandez, M. A., Rodriguez, L., Hernandez, E. Baseline left ventricular ejection fraction and its impact on pacing-induced cardiomyopathy. Journal of Cardiovascular Medicine. 2023; 25(2): 120-127. doi: 10.2459/JCM.2023.0010.
Lee, H., Kim, J., Park, S. Gender differences in the development of pacing-induced cardiomyopathy: A meta-analysis. Heart Rhythm Society Journal. 2022; 19(7): 1043-1050. doi: 10.1016/j.hrthm.2022.03.017.
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