Arrhythmias & electrophysiology
Left ventricular dysfunction after pacemaker implantation: Who could benefit from upfront conduction system pacing?
Authors' conclusion
Stricter definitions of PICM identify fewer patients but patients exposed to higher risk. A risk score can predict the occurrence of PICM and guide utilization of preventive conduction system pacing.
Study context
- Population
- Patients with baseline LVEF ≥50% undergoing pacemaker implantation, 2010–2020
- Participants
- 678 patients
- Exposure
- Pacing-induced cardiomyopathy (PICM) vs no PICM
Methodological detailslongitudinal, risk score development with internal validation, decision curve analysis
- Longitudinal
- Risk score development with internal validation
- Decision curve analysis
Main finding
As reported in the abstract
PICM incidence, by definition
19.6%-5.0%
PICM cases per 100 person years, by definition
4.7-1.1
PICM vs no PICM, composite end point (HR range across definitions)
3.23-5.23
Observational data: associations, not effects.
Further findings
Pre-implant risk score (native QRS width, LVEF, LV end-diastolic diameter, % RV pacing) for PICM
- AUC
- 0.710
- Good calibration
- >15% predicted probability threshold: net clinical benefit, unnecessary utilization of conduction system pacing and improved outcomes in high-risk subgroups (as printed)
- Internally validated
Parts of this Brief are withheld: the automatic checks could not confirm them against the abstract.
Original publication
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