Paced QRS duration and myocardial scar amount: predictors of long-term outcome of right ventricular apical pacing

Heart Vessels. 2016 Jul;31(7):1131-9. doi: 10.1007/s00380-015-0707-8. Epub 2015 Jul 4.

Abstract

Long-term right ventricular apical pacing (RVAP) is reportedly associated with heart failure (HF) development. However, the predictors of pacing-induced HF (PHF) remained unclear. We retrospectively enrolled 234 patients without structural heart disease who underwent a permanent pacemaker implantation with RVAP between 1982 and 2004. RVAP-induced HF was defined as left ventricular ejection fraction decrease >5 % with HF symptom without other HF development etiology. The QRS duration of a paced beat (pQRSd) and myocardial scar score were analyzed from each patient's 12-lead ECG. During a mean 15.6 years (range 3.3-30.0 years), 48 patients (20.5 %) patients developed RVAP-induced HF. The PHF group patients had a longer pQRSd (192.4 ± 13.5 vs. 175.7 ± 14.7 ms in non-PHF patients, p < 0.001) and a higher myocardial scar score (5.2 ± 1.9 vs. 2.7 ± 1.9, respectively p < 0.001). In multivariate Cox regression analysis, old age at implantation [Hazard ratio (HR) 1.62, 95 % confidential interval (CI) 1.22-2.16, p = 0.001], a longer pQRSd (HR 1.54, 95 % CI 1.15-2.05, p = 0.003), a higher myocardial scar score (HR 1.23, 95 % CI 1.03-1.49, p = 0.037), and a higher percentage of ventricular pacing (HR 1.31, 95 % CI 1.01-1.49, p = 0.010) were independent predictors of PHF. Based on the results of the receiver-operating characteristic (ROC) curve, the pQRSd cutoff was 185 ms (AUC 0.79, sensitivity 66.7 %, specificity 76.3 %) and myocardial scar score cutoff value was 4 (AUC 0.81, sensitivity 81.3 %, specificity 66.1 %). The pQRSd was positively correlated with scar score (r = 0.70, p < 0.001). pQRSd ≥185 ms and/or myocardial scar score ≥4 might be independent long-term prognostic markers of PHF.

Keywords: Myocardial scar; Paced QRS duration; Pacing-induced heart failure; Right ventricular apical pacing.

MeSH terms

  • Action Potentials
  • Adult
  • Aged
  • Area Under Curve
  • Arrhythmias, Cardiac / complications
  • Arrhythmias, Cardiac / diagnosis
  • Arrhythmias, Cardiac / physiopathology
  • Arrhythmias, Cardiac / therapy*
  • Cardiac Pacing, Artificial / adverse effects*
  • Cardiac Pacing, Artificial / methods
  • Chi-Square Distribution
  • Cicatrix / complications*
  • Cicatrix / diagnosis
  • Cicatrix / physiopathology
  • Electrocardiography
  • Female
  • Heart Failure / diagnosis
  • Heart Failure / etiology*
  • Heart Failure / physiopathology
  • Heart Rate*
  • Humans
  • Linear Models
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Myocardium / pathology*
  • Predictive Value of Tests
  • Proportional Hazards Models
  • ROC Curve
  • Republic of Korea
  • Retrospective Studies
  • Risk Factors
  • Time Factors
  • Treatment Outcome
  • Ventricular Function, Left
  • Ventricular Function, Right*