%0 Journal Article
%T Major determinant of the occurrence of pacing-induced cardiomyopathy in complete atrioventricular block: a multicentre, retrospective analysis over a 15-year period in South Korea
%A Jae-Hyeong Park
%A Jun Hyung Kim
%A Jung Yeon Chin
%A Ki-Woon Kang
%A Tae-Seok Kim
%A Yu Jeong Choi
%J -
%D 2018
%R 10.1136/bmjopen-2017-019048
%X Objectives The predictors of pacing-induced cardiomyopathy (PICM) for complete atrioventricular block (CAVB) have not yet been defined. The aim of this study was to investigate the major determinant of the occurrence of PICM.

Setting This is a multicentre, retrospective analysis of CAVB from tertiary referral centres in Daejeon, South Korea.

Participants A cohort of 900 consecutive patients with an implanted pacemaker was collected from December 2001 to August 2015. Of these, a total of 130 patients with CAVB with pacing-dependent rhythm who underwent ECG and echocardiogram before and after implantation were analysed for the occurrence of PICM.

Outcome measures Cox proportional hazards models evaluated the determinant of PICM by ECG, device parameters and echocardiogram over a mean of 4.5 years.

Results PICM was observed in 16.1% (n=21) of all patients with CAVB (age, 64¡À11 years; male, 36.2%). The preimplant left ventricular (LV) ejection fraction (66%¡À9% vs 66%¡À8%) and non-apical pacing (40.4% vs 33.3%) were similar; however, the native QRS duration (124¡À34 ms vs 149¡À32 ms) and the paced QRS duration (pQRSd) (139¡À29 ms vs 167¡À28 ms) were significantly different between the two groups. The postimplant LV ejection fraction (61%¡À7% vs 31%¡À8%) was also significantly different at the end of follow-up. A pQRSd significantly correlated with PICM (HR 1.05, 95%£¿CI 1.02 to 1.09, P=0.001). A pQRSd with a cut-off value of above 140 ms had a sensitivity of 95% while a pQRSd with a cut-off value of above 167 ms had a specificity of 90% for PICM.

Conclusion In patients with CAVB with pacing-dependent rhythm, regardless of the pacing site, the pQRSd is a major determinant of the occurrence of PICM
%U https://bmjopen.bmj.com/content/8/2/e019048