Paced QT interval as a risk factor for new-onset left ventricular systolic dysfunction and cardiac death after permanent pacemaker implantation

doi:10.1016/j.ijcard.2015.10.128

International Journal of Cardiology

Volume 203, 15 January 2016, Pages 158-163

https://doi.org/10.1016/j.ijcard.2015.10.128 Get rights and content

Abstract

Background

Prolongation of corrected QT (QTc) interval reflects an increased risk of fatal arrhythmia and cardiac death in various populations. However, it is not clear whether the paced-QTc (p-QTc) interval is associated with new-onset left ventricular systolic dysfunction (new-LVSD) or cardiac death.

Methods

In 491 consecutive patients (64 ± 14 years) with preserved LV ejection fraction (64 ± 7%), the p-QTc interval was measured within 2 weeks after PPM implantation. We assessed the rates of new-LVSD and cardiac death based on the degree of p-QTc interval.

Results

During the follow-up period (78 ± 51 months), new-LVSD and cardiac death were identified in 53 (10.8%) and 26 (5.3%) patients, respectively. Patients with new-LVSD had more frequent atrioventricular block (P = 0.041), a higher percentage of ventricular pacing (P = 0.005), a longer p-QRS duration (P < 0.001), and more prolonged p-QTc interval (P < 0.001) compared to those without new-LVSD. There was a graded increase in the rates of new-LVSD (P < 0.001) and cardiac death (P = 0.001) from the patients in the lowest to those in the highest tertile of the p-QTc interval. Additionally, the incidence of cardiac death was significantly elevated especially in the patients with new-LVSD and wider p-QTc interval. In Cox regression analyses, the p-QTc interval was independently associated with new-LVSD and cardiac death even after adjusted with various relevant confounding factors.

Conclusions

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.

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

Disclosures

The authors report no relationships that could be construed as a conflict of interest.

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View full text

Paced QT interval as a risk factor for new-onset left ventricular systolic dysfunction and cardiac death after permanent pacemaker implantation

Abstract

Background

Methods

Results

Conclusions

Introduction

Section snippets

Study population

Study population and baseline characteristics

Comparison between the patients with and without new-onset LV systolic dysfunction

New findings

Conclusion

Disclosures

Heart Rhythm.

Int. J. Cardiol.

Am. J. Cardiol.

Am. Heart J.

JACC Heart Fail

J. Am. Coll. Cardiol.

Heart Rhythm.

Int. J. Cardiol.

Int. J. Cardiol.

Am. J. Cardiol.

Int. J. Cardiol.

J. Am. Coll. Cardiol.

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Circulation

New-onset heart failure after permanent right ventricular apical pacing in patients with acquired high-grade atrioventricular block and normal left ventricular function

J. Cardiovasc. Electrophysiol.