This study will evaluate the association between right ventricular pacing and the risk of pacing-induced cardiomyopathy.
Background: Right ventricular (RV) pacing may lead to pacing-induced cardiomyopathy (PICM) and heart failure (HF). The detrimental effects of RV pacing have been attributed to the abnormal and dyssynchronous electrical and mechanical activation of the myocardium. The activation is affected by the RV pacing site. Understanding the consequences of different RV pacing sites and the patterns of dyssynchrony may help to choose the optimal treatment for the individual patient. Aim and objectives: The overall aim of this project is to investigate the association between RV pacing site and the risk of PICM. Contrast enhanced cardiac computed tomography (CT) will be applied for precise localization of the RV pacing. Furthermore, investigation of the association between PICM and different mechanical and electrical myocardial activation patterns during RV pacing will be conducted using new echocardiographic and electrocardiographic methods. Methods: The study is designed as a retrospective cohort study with clinical follow-up. Patients with prior pacemaker implantation due to advanced atrioventricular block will be included. The study baseline is retrospective and defined as time of pacemaker implantation and follow-up is time of inclusion. Baseline data will be extracted from the Danish Pacemaker- and ICD Registry, electronic medical records (EMR) and review of echocardiographs. Follow-up data will be extracted from existing data in the EMRs as well as generated during a follow-up visit with a clinical examination. For assessment of cardiac function, RV lead position and electrical and mechanical activations patterns, the examination will include a transthoracic echocardiography, an electrocardiogram, a 3-dimensional chest photo, and a contrast-enhanced cardiac CT. Data will be analysed for differences between those who develop PICM and those who do not. Expected outcomes and perspectives: The hope is that this project will generate knowledge and awareness on pacemaker treatment and the risk of PICM. Understanding the pathophysiology behind PICM is key to learning how to prevent it. Accordingly, this project has the potential to contribute to improving pacemaker treatment and the quality of care for the large and still growing PM population.
Study Type
OBSERVATIONAL
Enrollment
153
Right ventricular pacing from a DDD pacemaker implanted due to high-degree AV block
Department of Cardiology, Aalborg University Hospital
Aalborg, Denmark
Pacing-induced cardiomyopathy
Time to development of PICM. PICM is defined as ≥ 10% decrease in LVEF resulting in LVEF \< 50% after pacemaker implantation.
Time frame: After ≥ 1 years of exposure to right ventricular pacing
Composite endpoint of new-onset heart failure
HF diagnosis and/or HF hospitalization and/or Upgrading from a DDD PM to a CRT system after pacemaker implantation.
Time frame: After ≥ 1 year of exposure to right ventricular pacing
Change in LVEF
Change in LVEF after pacemaker implantation.
Time frame: After ≥ 1 year of exposure to right ventricular pacing
New-onset atrial fibrillation and/or atrial flutter
New diagnosis of atrial fibrillation and/or atrial flutter after pacemaker implantation.
Time frame: After ≥ 1 years of exposure to right ventricular pacing
Change in LV end-diastolic volume
Change in LV end-diastolic volume after pacemaker implantation.
Time frame: After ≥ 1 years of exposure to right ventricular pacing
Change in LV end-systolic volume
Change in LV end-systolic volume after pacemaker implantation.
Time frame: After ≥ 1 years of exposure to right ventricular pacing
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