Predictors of pacing-dependency in patients with cardiovascular implantable electronic devices
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), B-type 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 follow-up duration 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 betablockers 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 follow-up duration after implant.
Keywords: pacing-dependencypermanent pacemakerimplantable cardioverter- -defibrillator
References
- Brignole M, Auricchio A, Baron-Esquivias G, et al. ESC Committee for Practice Guidelines (CPG), Document Reviewers. 2013 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy: the Task Force on cardiac pacing and resynchronization therapy of the European Society of Cardiology (ESC). Developed in collaboration with the European Heart Rhythm Association (EHRA). Eur Heart J. 2013; 34(29): 2281–2329.
- Steyers CM. 3rd, khera R, bhave P. Pacemaker dependency after cardiac surgery: a systematic review of current evidence. PLoS One. 2015; 10: e0140340.
- Glikson M, Dearani JA, Hyberger LK, et al. Indications, effectiveness, and long-term dependency in permanent pacing after cardiac surgery. Am J Cardiol. 1997; 80(10): 1309–1313.
- Tang AS, Roberts RS, Kerr C, et al. Relationship between pacemaker dependency and the effect of pacing mode on cardiovascular outcomes. Circulation. 2001; 103(25): 3081–3085.
- Nagatomo T, Abe H, Kikuchi K, et al. New onset of pacemaker dependency after permanent pacemaker implantation. Pacing Clin Electrophysiol. 2004; 27(4): 475–479.
- Lelakowski J, Majewski J, Bednarek J, et al. Pacemaker dependency after pacemaker implantation. Cardiol J. 2007; 14(1): 83–86.
- Onalan O, Crystal A, Lashevsky I, et al. Determinants of pacemaker dependency after coronary and/or mitral or aortic valve surgery with long-term follow-up. Am J Cardiol. 2008; 101(2): 203–208.
- Merin O, Ilan M, Oren A, et al. Permanent pacemaker implantation following cardiac surgery: indications and long-term follow-up. Pacing Clin Electrophysiol. 2009; 32(1): 7–12.
- Raza SS, Li JM, John R, et al. Long-term mortality and pacing outcomes of patients with permanent pacemaker implantation after cardiac surgery. Pacing Clin Electrophysiol. 2011; 34(3): 331–338.
- Rene AG, Sastry A, Horowitz JM, et al. Recovery of atrioventricular conduction after pacemaker placement following cardiac valvular surgery. J Cardiovasc Electrophysiol. 2013; 24(12): 1383–1387.
- Sood N, Crespo E, Friedman M, et al. Predictors of pacemaker dependence and pacemaker dependence as a predictor of mortality in patients with implantable cardioverter defibrillator. Pacing Clin Electrophysiol. 2013; 36(8): 945–951.
- Korantzopoulos P, Letsas KP, Grekas G, et al. Pacemaker dependency after implantation of electrophysiological devices. Europace. 2009; 11(9): 1151–1155.
- Levine PA. Pacemaker dependency after pacemaker implantation. Cardiol J. 2007; 14(3): 318–320.
- Majewski JP, Lelakowski J. Pacemaker dependency: how should it be defined? Europace. 2018; 20(10): 1708.
- Feldman S, Glikson M, Kaplinsky E. Pacemaker dependency after coronary artery bypass. Pacing Clin Electrophysiol. 1992; 15(11 Pt 2): 2037–2040.
- Mar PL, Angus CR, Kabra R, et al. Perioperative predictors of permanent pacing and long-term dependence following tricuspid valve surgery: a multicentre analysis. Europace. 2017; 19(12): 1988–1993.
- Kaplan RM, Yadlapati A, Cantey EP, et al. Conduction recovery following pacemaker implantation after transcatheter aortic valve replacement. Pacing Clin Electrophysiol. 2019; 42(2): 146–152.
