Impact of permanent pacemaker implantation on clinical outcomes in patients with heart failure with mildly reduced ejection fraction
N Kuridze, K Etsadashvili, K H JalabadzeAbstract
Background
In patients with heart failure (HF), right ventricular (RV) pacing following permanent pacemaker (PPM) implantation has been associated with potential adverse outcomes, including worsening heart failure. This may be related to the percentage of RV pacing, the site of lead fixation within the RV, as well as the left ventricular ejection fraction (LVEF) at the time of implantation. This study aims to evaluate the impact of PPM implantation on HF progression in patients with heart failure with mildly reduced ejection fraction (HFmrEF) (LVEF 41-49%).
Purpose
To assess the association between PPM implantation and heart failure outcomes in patients with HFmrEF.
Methods
This study enrolled 84 patients with HFmrEF (NYHA I-II) (47 males (56%) and 37 females (44%), aged 35–94 years; mean age 72.8 years, SD = 10.69), all of whom were receiving optimal medical therapy for HF and had undergone PPM implantation (VVI(R): n=7, 8.3%; DDD(R): n=77, 91.7%) for either sick sinus syndrome (n=31, 36.9%) or high-grade atrioventricular block (n=53, 63.1%), with RV lead fixation in apical (n=34, 40.5%) or septal position (n=50, 59.5%), with an RV pacing of ≥40%. The baseline mean LVEF was 45.6% (SD = 2.21, range: 41%-49%). This study aimed to evaluate HF progression in HFmrEF patients after PPM implantation by assessing heart failure–related hospitalizations and changes in LVEF at 6 and 12 months, as well as the rate of patient transition from the HFmrEF group to either HF with reduced ejection fraction (HFrEF) or HF with preserved ejection fraction (HFpEF) groups at 12 months.
Results
After PPM implantation, the mean LVEF (45.6%) (SD = 2.21, range: 41%-49%) did not show a significant change. At 6 months, the mean LVEF was 46.05% (SD = 5.56, range: 30%-58%) and at 12 months - 46.1% (SD = 5.70, range: 33%-62%) (p>0.05). At least one episode of HF-related hospitalization occurred in 15 patients (17.9%) after 6 months of follow-up. Among these 15 patients, 11 (73.3%) experienced one episode, while 4 patients (26.7%) had two episodes of hospitalization. At the 12-month follow-up period, 21 patients (25%) experienced at least one episode of HF-related hospitalization. Among these, 15 patients (71.4%) had one episode, 2 patients (9.5%) had two episodes, and 4 patients (19%) experienced three episodes. Following PPM implantation, after 12 months, 16 patients (19%) transitioned to the HFrEF group, and 22 patients (26.2%) to the HFpEF group (Figure 1).
Conclusion
These findings suggest that in optimally treated HFmrEF patients, RV pacing ≥40% does not invariably lead to deterioration of cardiac function within the first year after PPM implantation, though individualized risk assessment and long-term follow-up remain essential.Figure 1.Results of the study