The following is a summary of “Optimizing patient selection for physiological pacing in bradyarrhythmia: factors associated with high ventricular pacing burden,” published in the April 2024 issue of Cardiology by Mannion et al.
Right ventricular (RV) pacing is common ventricular pacing (VP) for patients with bradyarrhythmia, but high pacing can lead to deterring left ventricular (LV) functionality, causing pacing-induced cardiomyopathy (PICM).
Researchers conducted a retrospective study identifying factors causing patients with increased RV with permanent pacemakers (PPM) for bradyarrhythmia.
They identified factors linked to VP burden > 20% to identify those at risk for PICM. They reviewed the most recent 300 consecutive cardiac implantable electronic devices (CIED) implants and collected medical history, electrocardiogram (ECG), echo, medication, and pacemaker check data.
The results showed that out of 236 patients, 35% had an RV pacing burden below 20%, while 65% had a VP burden at or above 20%. Almost all (96.2%) with complete heart block (CHB) paced over 20% (P=0.002). The use of DDD or VVI modes (75.2% and 89.2% patients) without mode switch algorithms correlated with higher pacing rates (VP> 20%), P<0.001). Male gender or prior coronary artery bypass grafting (CABG) also increased pacing rates. Other factors like prolonged PR interval, atrial fibrillation, or older age showed trends toward significance.
Investigators concluded that high-grade atrioventricular (AV) block correlated with RV pacing over 20% across three years but not in patients with only temporary episodes. Male sex, prior CABG, and lack of mode-switching algorithms were significantly linked to high pacing rates.
Source: cardiologyres.org/index.php/Cardiologyres/article/view/1598/1564
