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Survival of patients with pacing‐induced cardiomyopathy upgraded to CRT does not depend on defibrillation therapy
Author(s) -
Loboda Danuta,
Gibinski Michal,
Zietek Karolina,
Wilczek Jacek,
Gardas Rafal,
GladyszWanha Sylwia,
Golba Krzysztof S.
Publication year - 2020
Publication title -
pacing and clinical electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.686
H-Index - 101
eISSN - 1540-8159
pISSN - 0147-8389
DOI - 10.1111/pace.13906
Subject(s) - medicine , ejection fraction , cardiac resynchronization therapy , cardiology , implantable cardioverter defibrillator , heart failure , ventricle , cardiomyopathy , defibrillation , qrs complex , atrial fibrillation , clinical endpoint , retrospective cohort study , randomized controlled trial
Background Permanent right ventricular pacing (RVP) results in cardiac dyssynchrony that may lead to heart failure and may be an indication for the use of cardiac resynchronization therapy (CRT). The study aimed to evaluate predictors of outcomes in patients with pacing‐induced cardiomyopathy (PICM) if upgraded to CRT. Methods One hundred fifteen patients, 75.0 years old (IQR 67.0–80.0), were upgraded to CRT due to the decline in left ventricle ejection fraction (LVEF) caused by the long‐term RVP. A retrospective analysis was performed using data from hospital and outpatient clinic records and survival data from the National Health System. Results The prior percentage of RVP was 100.0% (IQR 97.0‐100.0), with a QRS duration of 180.0 ms (IQR 160.0‐200.0). LVEF at the time of the upgrade procedure was 27.0% (IQR 21.0‐32.75). The mean follow‐up was 980 ± 522 days. The primary endpoint, death from any cause, was met by 26 (22%) patients. Age > 82 years (HR 5.96; 95% CI 2.24‐15.89; P = .0004) and pre‐CRT implantation LVEF < 20% (HR 5.63; 95%CI 2.19‐14.47; P = .0003), but neither the cardioverter‐defibrillator (ICD) implantation (HR 1.00; 95%CI 0.45–2.22; P = 1.00), nor the presence of atrial fibrillation (HR 1.22; 95%CI 0.56–2.64; P = .62), were independently associated with all‐cause mortality. Conclusion Advanced age and an extremely low LVEF, but neither the presence of atrial fibrillation nor implanting an additional high voltage lead, influence the all‐cause mortality in patients after long‐term RVP, when upgraded to CRT.