Author + information
- Received July 24, 2017
- Revision received October 2, 2017
- Accepted October 4, 2017
- Published online February 19, 2018.
- Shaan Khurshid, MDa,
- Edmond Obeng-Gyimah, MDb,
- Gregory E. Supple, MDb,
- Robert Schaller, DOb,
- David Lin, MDb,
- Anjali T. Owens, MDc,
- Andrew E. Epstein, MDb,
- Sanjay Dixit, MDb,
- Francis E. Marchlinski, MDb and
- David S. Frankel, MDb,∗ ()
- aCardiology Division, Massachusetts General Hospital, Boston, Massachusetts
- bElectrophysiology Section, Cardiovascular Division, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
- cHeart Failure Section, Cardiovascular Division, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
- ↵∗Address for correspondence:
Dr. David S. Frankel, Cardiovascular Division, Electrophysiology Section, Perelman School of Medicine at the University of Pennsylvania, 9 Founders Pavilion, 3400 Spruce Street, Philadelphia, Pennsylvania 19104.
Objectives This study sought to determine the extent, time course, and predictors of improvement following cardiac resynchronization therapy (CRT) upgrade among pacing-induced cardiomyopathy (PICM) patients.
Background PICM is an important cause of heart failure in patients exposed to frequent right ventricular (RV) pacing. CRT may reverse PICM.
Methods We retrospectively studied 1,279 consecutive patients undergoing CRT procedures between 2003 and 2016. Patients undergoing CRT upgrade from a dual-chamber or single-chamber ventricular pacemaker for PICM were included. PICM was defined as decrease of ≥10% in left ventricular ejection fraction (LVEF), resulting in LVEF <50% among patients experiencing ≥20% RV pacing without an alternative cause of cardiomyopathy. Severe PICM was defined as pre-upgrade LVEF ≤35%. Clinical, electrocardiographic, and echocardiographic characteristics associated with both the extent of LVEF recovery and with post-upgrade LVEF of >35% among those with severe PICM were identified.
Results Of 69 PICM patients, LVEF improved from 29.3% to 45.3% over a median 7.0 months. Of 54 patients with severe PICM, 39 (72.2%) improved to LVEF >35% over a median 7.0 months. Most improvement occurred within the first 3 months, although improvement continued over the remainder of the first year. In linear regression, narrower native QRS was associated with greater LVEF improvement following CRT upgrade (+2.00% per 10-ms decrease; p = 0.05).
Conclusions CRT is highly efficacious in reversing PICM, with 72% of severe PICM patients achieving LVEF >35% and most of the improvement occurring within 1 year. These data support initial upgrade to a CRT pacemaker with consideration of further upgrade to CRT defibrillator after 1 year if LVEF remains ≤35%.
- biventricular pacing
- cardiac resynchronization therapy
- heart failure
- pacing-induced cardiomyopathy
This work was supported by the Koegel Family Electrophysiology Fund. Drs. Epstein and Marchlinski are consultants and compensated speakers for St. Jude Medical, Medtronic, Boston Scientific, and Biotronik. Dr. Lin is a consultant and compensated speaker for St. Jude Medical. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
All authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Clinical Electrophysiology author instructions page.
- Received July 24, 2017.
- Revision received October 2, 2017.
- Accepted October 4, 2017.
- 2018 American College of Cardiology Foundation
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