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Original Article
Published online: 2019-09-04
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Predictors of pacing-dependency in patients with cardiovascular implantable electronic devices

Wolfram Grimm, Kathrin Grimm, Brandon Greene, Mariana Parahuleva
DOI: 10.5603/CJ.a2019.0088
·
Pubmed: 31489608

open access

Ahead of print
Original articles
Published online: 2019-09-04

Abstract

Background: Data on the prevalence and predictors for the development of pacing-dependency in patients with cardiovascular implantable electronic devices (CIEDs) are sparse.

Methods: Pacing-dependency defined as an absence of intrinsic rhythm of  ≥ 30 bpm was determined in 802 consecutive patients with CIEDs who visited the documented pacemaker or implantable cardioverter-defibrillator outpatient clinic for routine follow-up.

Results: A total of 131 (16%) patients were found to be pacing-dependent 67 ± 70 months after CIED implant. Multivariate analysis revealed a significant association between pacing-dependency and the following clinical variables: second or third-degree atrioventricular (AV) block at implant (OR = 19.9; 95% CI: 10.9–38.5, p < 0.01), atrial fibrillation at implant (OR = 2.15; 95% CI: 1.16–4.05, p = 0.02), left ventricular ejection fraction (LVEF) ≤ 30% (OR = 2.06; 95% CI: 1.03–4.15, p = 0.04), brain natriuretic peptide (BNP) > 150 pg/mL (OR = 2.12; 95% CI: 1.16–3.97, p = 0.02), chronic kidney disease (OR = 1.86; 95% CI: 1.08–3.26, p = 0.03), and during follow-up after implantation > 5 years (OR = 3.29; 95% CI: 1.96–5.64, p < 0.01). None of the remaining clinical variables including age, gender, diabetes mellitus, underlying heart disease, prior cardiac surgery or medication during follow-up including beta-blockers and amiodarone predicted pacing-dependency.

Conclusions: Pacing-dependency is associated with second or third-degree AV-block at implant, atrial fibrillation before implant, low LVEF, elevated BNP, chronic kidney disease and during follow-up after implant.

Abstract

Background: Data on the prevalence and predictors for the development of pacing-dependency in patients with cardiovascular implantable electronic devices (CIEDs) are sparse.

Methods: Pacing-dependency defined as an absence of intrinsic rhythm of  ≥ 30 bpm was determined in 802 consecutive patients with CIEDs who visited the documented pacemaker or implantable cardioverter-defibrillator outpatient clinic for routine follow-up.

Results: A total of 131 (16%) patients were found to be pacing-dependent 67 ± 70 months after CIED implant. Multivariate analysis revealed a significant association between pacing-dependency and the following clinical variables: second or third-degree atrioventricular (AV) block at implant (OR = 19.9; 95% CI: 10.9–38.5, p < 0.01), atrial fibrillation at implant (OR = 2.15; 95% CI: 1.16–4.05, p = 0.02), left ventricular ejection fraction (LVEF) ≤ 30% (OR = 2.06; 95% CI: 1.03–4.15, p = 0.04), brain natriuretic peptide (BNP) > 150 pg/mL (OR = 2.12; 95% CI: 1.16–3.97, p = 0.02), chronic kidney disease (OR = 1.86; 95% CI: 1.08–3.26, p = 0.03), and during follow-up after implantation > 5 years (OR = 3.29; 95% CI: 1.96–5.64, p < 0.01). None of the remaining clinical variables including age, gender, diabetes mellitus, underlying heart disease, prior cardiac surgery or medication during follow-up including beta-blockers and amiodarone predicted pacing-dependency.

Conclusions: Pacing-dependency is associated with second or third-degree AV-block at implant, atrial fibrillation before implant, low LVEF, elevated BNP, chronic kidney disease and during follow-up after implant.

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Keywords

pacing-dependency, permanent pacemaker, implantable cardioverter-defibrillator

About this article
Title

Predictors of pacing-dependency in patients with cardiovascular implantable electronic devices

Journal

Cardiology Journal

Issue

Ahead of print

Article type

Original Article

Published online

2019-09-04

DOI

10.5603/CJ.a2019.0088

Pubmed

31489608

Keywords

pacing-dependency
permanent pacemaker
implantable cardioverter-defibrillator

Authors

Wolfram Grimm
Kathrin Grimm
Brandon Greene
Mariana Parahuleva

References (17)
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