Comparative analysis of pacing-induced cardiomyopathy (picm) between leadless and transvenous pacemakers: a 10-year experience from a southeast asian national heart centre
N M A S Atan, S H Kamsani, Z Ali, A Sahat, A Said, H Aziman, Z Zahir, R Rebo, H Zamberi, M Y Low, S Khalae, A HussinAbstract
Background
Pacing-induced cardiomyopathy (PICM) is a recognized complication of chronic right ventricular (RV) pacing due to electrical and mechanical dyssynchrony that leading to adverse ventricular remodeling. The emergence of leadless pacemakers (LP) offers a novel alternative to conventional transvenous pacemakers (TVP, eliminating the risk of lead and pocket complications. However, it remains uncertain whether the risk of ventricular dysfunction differs compared with conventional transvenous pacemakers (TVP). Existing data on PICM incidence with LP are limited and largely derived from western populations, with scarce evidence from real world Southeast Asian cohorts.
Purpose
To compare the prevalence and predictors of PICM between LP and TVP recipients in a large Southeast Asian cohort.
Methods
We retrospectively analyzed all patients who underwent permanent pacemaker implantation at our National Heart Institute, Malaysia, between 2013 and 2023. PICM was defined as a reduction in left ventricular ejection fraction (LVEF) of >10% from baseline >50% to <50%, in the absence of alternative causes of cardiomyopathy. Clinical, echocardiographic, and electrocardiographic parameters were compared between LP and TVP recipients. Logistic regression analyses were performed to identify independent predictors of PICM.
Results
Among 4,137 pacemaker recipients, 1,053 (25.5%) fulfilled inclusion criteria, and 244 (23.2%) developed PICM. PICM prevalence was 22% in TVP and 32% in LP recipients. Within the LP subgroup, Micra VR showed a higher PICM rate (37%) compared with Micra AV (21%). Patients who developed PICM were more likely to be male (61.1% vs. 44.6%, p < 0.001), implanted for atrioventricular block (52.5% vs. 37.5%, p < 0.001), and to have post-implant QRS ≥140 ms (61.9% vs. 42.5%, p < 0.001) and RV pacing burden > 40% (81.1% vs. 47.0%, p < 0.001). In univariate analysis, post-implant QRS duration (p = 0.002) was significantly associated with PICM in LP, while in TVP, male sex (p = 0.003) and higher RV pacing burden (p < 0.001) were dominant predictors. Median time to PICM onset was 3 years (IQR 1–5) for TVP and 2 years (IQR 1–3) for LP.
Conclusion(s)
PICM occurred in nearly one-quarter of pacemaker recipients in this large South East Asian cohort, with a higher rate observed among leadless device users. This is the largest PICM study cohort in region up to date. Male sex, higher RV pacing burden and wider post-implant QRS duration were the dominant independent predictors of PICM. These findings support the implementation of structured post-implant surveillance and prioritization of physiologic pacing strategies. Further large scale multicentre prospective validation studies are warranted to validate these predictors and developed a dedicated PICM risk calculator to individualize pacing strategy selection.Prevalance PICM comparing TVP and LPPICM PREDICTORS ANALYSIS