Int J Arrhythm.  2022 Dec;23(4):26. 10.1186/s42444-022-00078-8.

Impact of diastolic dysfunction in patients with preserved ejection fraction undergoing permanent cardiac pacemaker placement

• Jeong H
• Kim H
• Kim S
• Kim H
• Ki Y
• Choi D
• Park K
• Lee K
• Yoon N
• Park H
• Cho J

• KMID: 2537663
• DOI: http://doi.org/10.1186/s42444-022-00078-8

Abstract

Background
Chronic right-ventricular (RV) pacing can exacerbate heart failure in patients with a low ejection fraction (EF). There is little information on the effects of diastolic dysfunction (DD) in patients with preserved EF undergoing permanent pacemaker (PPM) placement. We aimed to investigate the clinical outcomes in these patients.
Methods
This multicenter, retrospective analysis of PPM use in Chonnam, South Korea, included all patients with preserved EF undergoing transvenous PPM implantation for atrioventricular blockage from 2017 to 2019. Patients were divided into two groups according to DD, which were assessed by including mitral flow velocities (E′ velocity, E/E′ ratio), peak velocity of the tricuspid regurgitant, and left atrial maximum volume index. Composite outcomes were defined as (1) cardiovascular death, and (2) hospitalization by heart failure during the follow-up period.
Results
One hundred sixty-seven patients (66 men; overall mean age, 75.3 ± 11.9 years) were divided into two groups: 125 normal versus 42 DD. Compared with normal subjects, the DD group included older patients (mean age, 79.1 ± 9.9 vs. 74.0 ± 12.3; p = 0.016), and had longer paced QTc interval (pQTc, 168.5 ± 20.1 vs. 159.1 ± 16.3  ms; p < 0.001). Fifteen patients were hospitalized and two died. In a Cox proportional regression analysis, DD (hazard ratio [HR], 7.343; 95% confidence interval [CI], 2.035–26.494; p = 0.002) and pQRSd (HR, 1.046; 95% CI, 1.004–1.091; p = 0.033) were independent predictors of composite outcomes.
Conclusion
In patients with DD, RV pacing raised the risk of pacing-induced heart failure despite preserved leftventricular function. Thus, patients with DD should be monitored intensively.

Keyword

Artificial pacemaker; Congestive heart failure; Ventricular pacing; Diastolic dysfunction