Upgrading to biventricular pacing or left bundle branch area pacing in the treatment of pacemaker-induced cardiomyopathy
M Dogan, U Canpolat, A Kivrak, A H Ates, K AytemirAbstract
Background
Pacing-induced cardiomyopathy (PiCM) is a recognized complication of chronic right ventricular (RV) pacing, yet optimal management remains debated. Upgrading to biventricular pacing (BiVP) or left bundle branch area pacing (LBBaP) may reverse dysfunction, but comparative data are limited.
Objective
To compare the efficacy and safety of upgrading to BiVP versus LBBaP in patients with PiCM.
Methods
In this single-center retrospective cohort, 31 patients with symptomatic PiCM underwent upgrade to BiVP (n=16) or LBBaP (n=15) between 2014 and 2024. PiCM was defined as a >10% absolute LVEF decline to <50% with RV pacing >20%. Clinical (NYHA class), electrocardiographic (paced QRS duration), and echocardiographic (LVEF, LVEDD) parameters were assessed before and after upgrade. ROC analysis evaluated paced QRS reduction for predicting LVEF normalization.
Results
Median follow-up was 10.0 months. Both groups showed significant NYHA class improvement, QRS narrowing, and LVEF increase (BiVP: +8.44%, LBBaP: +6.60%; p=0.859 between groups). No significant intergroup differences were observed for any clinical or echocardiographic outcomes. A paced QRS reduction ≥41 ms predicted LVEF ≥50% with 80% sensitivity and 81% specificity (AUC=0.876, p=0.001). No major device-related complications occurred.
Conclusions
BiVP and LBBaP upgrades yield comparable short-term improvements in functional status, ventricular function, and electrical synchrony in PiCM. Paced QRS reduction may serve as a helpful marker of recovery. Larger, prospective studies are warranted to confirm these findings.