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Title: An assessment of mortality in patients with advanced heart blocks qualified for de novo dual-chamber classical pacing
Abstract:
Introduction Pacemaker implantation and right ventricular pacing has been a therapeutic strategy used for nearly 60 years to prolong the lives of patients with advanced atrioventricular block (AVB). Despite the obvious benefits of this therapy, the deleterious effects of prolonged classical right ventricular pacing, such as desynchronization of ventricular contraction and prolongation of QRS complex duration, negatively affect the patient's quality of life and in some patients, lead to the development of pacing cardiomyopathy and heart failure. This justifies research into the factors leading to earlier mortality in classically paced patients to identify patients who may particularly benefit from physiologic pacing. Objective To analyze the survival of patients with advanced AVB who are eligible for de novo pacemaker implantation to identify factors affecting mortality. Methods A retrospective analysis of 683 consecutive patients admitted to the 1st Department of Cardiology of the University Hospital of Krakow for de novo implantation due to advanced AVB between 2007 and 2015 was performed. Early (up to 2 years) and late (up to 5 years) mortality was evaluated. The influence of comorbidities, ECG parameters such as pre- and post-implantation QRS complex duration and QRS fragmentation, and right ventricular pacing sites (apex, septum, free wall, outflow trajectories) were analyz ; ed. Results The 2-year mortality rate was 18.2% and the 5-year mortality rate was 39.4%. It was found that factors such as age at admission, duration of paced QRS complex, ejection fraction, previous myocardial infarction, heart failure, valvular disease, elevated creatinine levels at admission, and patients who had electrodes implanted in the apex or mid-septum appeared to be independent risk factors. Medications such as furosemide and amiodarone were also found to be more common in patients who died. Although not found to be an independent risk factor, fragmentation of the QRS complex after implantation appeared to be more common in patients with a more prolonged QRS complex. Conclusions Patients with a stimulated QRS duration >160 ms, baseline reduced ejection fraction, history of myocardial infarction, diabetes mellitus, atrial fibrillation, cardiomyopathies and valvular heart disease, as well as those with electrodes implanted in the apex or mid-septum, represent patients at the highest risk of death. More frequent screening, such as echocardiography, electrocardiogram analysis and pharmacological intervention, should be performed routinely to determine which patients should be eligible for earlier pacing system modification for resynchronization therapy or pacemaker stimulation.
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Rada Dyscypliny Nauki medyczne
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Last modified:
Feb 17, 2025
In our library since:
Feb 17, 2025
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http://dl.cm-uj.krakow.pl:8080/publication/5202
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| Edition name | Date |
|---|---|
| UJCMc709e52408f042aa9e48887c3bb55409 | Feb 17, 2025 |
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