Reversal of Pacing-Induced Cardiomyopathy Following Cardiac?Resynchronization Therapy

摘要

ObjectivesThis study sought to determine the extent, time course, and predictors of improvement following cardiac resynchronization therapy (CRT) upgrade among pacing-induced cardiomyopathy (PICM) patients. BackgroundPICM is an important cause of heart failure in patients exposed to frequent right ventricular (RV) pacing. CRT may reverse PICM. MethodsWe retrospectively studied 1,279 consecutive patients undergoing CRT procedures between 2003 and 2016.?Patients undergoing CRT upgrade from a dual-chamber or single-chamber ventricular pacemaker for PICM were?included. PICM was defined as decrease of?≥10% in left ventricular ejection fraction (LVEF), resulting in LVEF 35% among those with severe PICM were identified. ResultsOf 69 PICM patients, LVEF improved from 29.3% to 45.3% over a median 7.0 months. Of 54 patients with severe PICM, 39 (72.2%) improved to LVEF >35% over a median 7.0 months. Most improvement occurred within the?first?3 months, although improvement continued over the remainder of the first year. In linear regression, narrower?native QRS was associated with greater LVEF improvement following CRT upgrade (+2.00% per 10-ms decrease; p?=?0.05). ConclusionsCRT is highly efficacious in reversing PICM, with 72% of severe PICM patients achieving LVEF?>35%?and most of the improvement occurring within 1 year. These data support initial upgrade to a CRT pacemaker?with?consideration of further upgrade to CRT defibrillator after 1 year if LVEF remains ≤35%.