BACKGROUND
Long-term adverse cardiac effects of right ventricular (RV) pacing in patients with normal left ventricular (LV) ejection fraction (EF) are not well studied.
OBJECTIVES
The purpose of this study was to evaluate adverse effects of RV apical pacing in patients with normal LVEF.
METHODS
Medical records of patients who had undergone RV apical pacemaker implantation for pacing indications and had an LVEF >= 50% were reviewed to determine the effect of RV pacing burden on LV systolic and diastolic function, mechanical dyssynchrony, heart failure hospitalization (HFH), and all-cause mortality.
RESULTS
Of the 875 eligible patients from a single center, 459 patients met the inclusion criteria, 185 had <50% RV, and 274 had >= 50% RV pacing burden over a median 4.98 years (IQR: [3.2, 7.0]) of follow-up. LVEF in the >= 50% pacing group (median 63% [IQR: 58%, 67%]) and <50% group (median 64% [IQR: 60, 67])...
Show moreBACKGROUND
Long-term adverse cardiac effects of right ventricular (RV) pacing in patients with normal left ventricular (LV) ejection fraction (EF) are not well studied.
OBJECTIVES
The purpose of this study was to evaluate adverse effects of RV apical pacing in patients with normal LVEF.
METHODS
Medical records of patients who had undergone RV apical pacemaker implantation for pacing indications and had an LVEF >= 50% were reviewed to determine the effect of RV pacing burden on LV systolic and diastolic function, mechanical dyssynchrony, heart failure hospitalization (HFH), and all-cause mortality.
RESULTS
Of the 875 eligible patients from a single center, 459 patients met the inclusion criteria, 185 had <50% RV, and 274 had >= 50% RV pacing burden over a median 4.98 years (IQR: [3.2, 7.0]) of follow-up. LVEF in the >= 50% pacing group (median 63% [IQR: 58%, 67%]) and <50% group (median 64% [IQR: 60, 67]) decreased to 59.5% (IQR: [51%, 63%]) and 62% (IQR: [55%, 66%]), absolute median decrease 6.0 (IQR: [1, 10]) vs 3.0 (IQR: [4, 10]), P = 0.001 in the 2 groups, respectively. On multivariate analysis, RV pacing >= 50% (OR: 2.44 [95% CI: 1.43-4.16]; P = 0.001), baseline LVEF (HR: 0.95 [95% CI: 0.92-0.98]; P = 0.0008), relative decrease of >10% LVEF (HR: 1.73 [95% CI:1.09-2.75]), baseline E/e' ratio (HR: 1.07 [95% CI: 1.05-1.11]; P < 0.0001), and LV mechanical dyssynchrony by strain imaging performed in 193 subjects (HR: 1.031 [95% CI: 1.012-1.051]; P < 0.001) were predictors of HFH. Baseline mechanical dyssynchrony (HR: 1.024 [95% CI: 1.008-1.04]; P < 0.01), its worsening by 25% (HR: 2.077 [95% CI: 1.109-3.89]; P < 0.03), and baseline E/e' (HR: 1.063 [95% CI: 1.025-1.10]; P < 0.01) were predictors of all-cause mortality.
CONCLUSIONS
In patients with normal baseline LVEF, chronic apical RV pacing of >= 50% is associated with worse LV systolic function, LV mechanical dyssynchrony, and increases HFH. (JACC Adv. 2025;4:102007) (c) 2025 The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
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