Paced QT interval as a risk factor for new-onset left ventricular systolic dysfunction and cardiac death after permanent pacemaker implantation
Introduction
Permanent pacemaker (PPM) implantation is the only safe and effective treatment for patients with symptomatic sinus node dysfunction or atrioventricular block (AVB). However, long-standing right ventricular (RV) pacing is frequently associated with deterioration of left ventricular (LV) function and heart failure (HF) in selected patients [1], [2]. Several risk factors have been suggested for the adverse outcomes such as preexisting LV dysfunction, RV apical pacing location, pacing-induced LV dyssynchrony represented by prolonged paced-QRS duration (p-QRSd), and high percentage of RV pacing (RVp%) [3], [4], [5], [6].
On the other hand, prolonged corrected QT (QTc) interval was often found in patients with advanced chronic HF and shown to be a powerful predictor of ventricular arrhythmia and mortality in this patient group [7], [8], [9]. However, the relation of paced-QTc (p-QTc) interval to new-onset LV systolic dysfunction (new-LVSD) and cardiac death following PPM implantation has never been evaluated. Therefore, the purpose of this study is to assess whether the prolonged p-QTc interval is associated with the development of new-LVSD or cardiac death after PPM implantation in patients with preserved LV systolic function.
Section snippets
Study population
In all patients undergoing PPM implantation at the Samsung Medical Center (Seoul, Korea), routine clinical, electrocardiographic, echocardiographic, and pacing parameters are prospectively collected and entered into our PPM database. To focus our analysis on the development of new-LVSD and cardiac death after the PPM implantation, patients with baseline LV ejection fraction (EF) < 50% were excluded. Patients with lack of p-QRS complex on the 12-lead ECG, implantable cardioverter-defibrillator,
Study population and baseline characteristics
Mean (± SD) age of the 491 patients was 64 ± 14 years. Proportions of patients with male gender and hypertension were 48 and 44%, respectively. Mean (± SD) value of LV EF was 64 ± 7%. A total of 491 patients with sinus node dysfunction (n = 262, 53%), complete AVB (n = 196, 40%), or other forms of AVB (n = 33, 7%) were treated by pacemakers with DDD/DDDR (n = 261, 53%), VVI/VVIR (n = 210, 43%), or VDD (n = 20, 4%) mode.
Comparison between the patients with and without new-onset LV systolic dysfunction
During the mean follow-up of 78 ± 51 months, 53 (11%) patients were identified to develop new-LVSD
New findings
The present study is the first to reveal a significant association between the degree of p-QTc interval and the development of new-LVSD and cardiac death after PPM implantation in patients with preserved LV systolic function. We also found the adverse effect of p-QTc prolongation on the cardiac death significantly increased in patients with new-LVSD after PPM implantation. The p-QTc interval was identified as an independent risk factor for the clinical outcomes even after adjusted with multiple
Conclusion
Prolonged p-QTc interval was closely associated with new-LVSD and cardiac death after PPM implantation in patients with preserved LV systolic function. The rate of cardiac death significantly increased especially in patients who showed more p-QTc widening along with new-LVSD. Therefore, close follow-up might be warranted for patients who showed longer p-QTc interval after PPM implantation.
Disclosures
The authors report no relationships that could be construed as a conflict of interest.
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