Risk of Pacing-Induced Cardiomyopathy in Patients with High-Degree Atrioventricular Block—Impact of Right Ventricular Lead Position Confirmed by Computed Tomography
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Population
2.2. Clinical Characteristics and Outcomes
2.3. Pacemaker Implantation and Interrogation
2.4. Cardiac Computed Tomography—Acquisition and Analysis
2.5. Echocardiography
2.6. Statistical Analysis
3. Results
3.1. Patient Selection
3.2. CT-Determined RV Lead Position
3.3. Clinical Characteristics in Patients with Septal and Non-Septal RV Lead Position
3.4. Outcomes and RV Lead Position
4. Discussion
4.1. Main Findings
4.2. The Importance of RV Lead Position—Fluoroscopy versus Cardiac CT
4.3. Risk of PICM—Comparison with Previous Studies
4.4. Limitations
4.5. Future Directions
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Variables | Non-Septal (n = 105) | Septal (n = 48) | p-value | All (n = 153) |
Age (y) | 72.9 (64.6–77.7) | 72.0 (66.3–75.8) | 0.92 | 72.1 (64.7–76.9) |
Male sex | 72 (68.6) | 31 (64.6) | 0.71 | 103 (67.3) |
LVEF (%) | 60.2 ± 3.5 | 60.6 ± 3.8 | 0.51 | 60.3 ± 3.6 |
QRS duration (ms) | 119 ± 30 | 120 ± 29 | 0.74 | 119 ± 30 |
Comorbidity | ||||
Ischemic heart disease | 5 (4.8) | 7 (14.6) | 0.05 | 12 (7.8) |
Valvular heart disease | 7 (6.7) | 5 (10.4) | 0.52 | 12 (7.8) |
Atrial fibrillation | 11 (10.5) | 4 (8.3) | 0.78 | 15 (9.8) |
Hypertension | 70 (66.7) | 36 (75.0) | 0.35 | 106 (69.3) |
Diabetes | 24 (22.9) | 11 (22.9) | 1.00 | 35 (22.9) |
History of smoking | 41 (39.1) | 24 (50.0) | 0.22 | 65 (42.5) |
eGFR (mL/min/1.73 m2) | 75.3 ± 16.2 | 73.8 ± 13.6 | 0.57 | 74.8 ± 15.4 |
Medical therapy | ||||
RAS-acting agents | 52 (49.5) | 30 (62.5) | 0.16 | 82 (53.6) |
Betablocker | 20 (19.1) | 9 (18.8) | 1.00 | 29 (19.0) |
Loop diuretics | 12 (11.4) | 3 (6.3) | 0.39 | 15 (9.8) |
Aldosterone antagonist | 5 (5.8) | 3 (6.3) | 0.71 | 8 (5.2) |
Outcomes | All (n = 153) | Non-Septal (n = 105) | Septal (n = 48) | RR | 95% CI | p-value |
---|---|---|---|---|---|---|
PICM | 47 (30.7) | 31 (29.5) | 16 (33.3) | 0.89 | 0.54; 1.46 | 0.63 |
CRT upgrade | 9 (5.9) | 6 (5.7) | 3 (6.3) | 0.91 | 0.23; 3.52 | 0.90 |
New-onset AF | 22 (14.4) | 14 (13.3) | 8 (16.7) | 0.80 | 0.36; 1.78 | 0.59 |
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Fruelund, P.Z.; Sommer, A.; Frøkjær, J.B.; Lundbye-Christensen, S.; Zaremba, T.; Søgaard, P.; Graff, C.; Vraa, S.; Mahalingasivam, A.A.; Thøgersen, A.M.; et al. Risk of Pacing-Induced Cardiomyopathy in Patients with High-Degree Atrioventricular Block—Impact of Right Ventricular Lead Position Confirmed by Computed Tomography. J. Clin. Med. 2022, 11, 7228. https://doi.org/10.3390/jcm11237228
Fruelund PZ, Sommer A, Frøkjær JB, Lundbye-Christensen S, Zaremba T, Søgaard P, Graff C, Vraa S, Mahalingasivam AA, Thøgersen AM, et al. Risk of Pacing-Induced Cardiomyopathy in Patients with High-Degree Atrioventricular Block—Impact of Right Ventricular Lead Position Confirmed by Computed Tomography. Journal of Clinical Medicine. 2022; 11(23):7228. https://doi.org/10.3390/jcm11237228
Chicago/Turabian StyleFruelund, Patricia Zerlang, Anders Sommer, Jens Brøndum Frøkjær, Søren Lundbye-Christensen, Tomas Zaremba, Peter Søgaard, Claus Graff, Søren Vraa, Aksayan Arunanthy Mahalingasivam, Anna Margrethe Thøgersen, and et al. 2022. "Risk of Pacing-Induced Cardiomyopathy in Patients with High-Degree Atrioventricular Block—Impact of Right Ventricular Lead Position Confirmed by Computed Tomography" Journal of Clinical Medicine 11, no. 23: 7228. https://doi.org/10.3390/jcm11237228