Effect of Medical Therapy on Reducing the Risk of Pacing‐Induced Cardiomyopathy
Background High right ventricular pacing burden can result in pacing‐induced cardiomyopathy (PICM). The goal of this study was to investigate whether angiotensin‐converting enzyme inhibitors (ACEI), angiotensin receptor blockers (ARB), and β‐blockers (BB) are associated with a reduction in risk of P...
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| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Wiley
2025-07-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.124.040415 |
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| Summary: | Background High right ventricular pacing burden can result in pacing‐induced cardiomyopathy (PICM). The goal of this study was to investigate whether angiotensin‐converting enzyme inhibitors (ACEI), angiotensin receptor blockers (ARB), and β‐blockers (BB) are associated with a reduction in risk of PICM in patients with high right ventricular pacing burden. Methods This was a single‐center, retrospective study that included patients with normal ejection fraction and complete heart block who underwent pacemaker implantation. The medical therapy group included patients who received ACEI/ARB, BB, or both. The control group received neither ACEI/ARB nor BB. The primary end point was PICM, defined as upgrade to a biventricular device or reduction in ejection fraction to ≤40% without another cause identified. Fine‐Gray subdistribution hazard models were used to determine the relationship between medical therapy and cumulative incidence of PICM. Results The study included 642 patients (mean±SD age, 71±14 years; 51% women). Over 10 years of follow‐up, 76 (11.8%) received ACEI/ARB only; 49 (7.6%) received BB only, and 86 (13.4%) received both. PICM occurred in 10 of 211 in the medical therapy group (4.7%) and in 30 of 431 in the control group (7.0%). In adjusted weighted analyses, the risk of PICM was significantly lower in the medical therapy group compared with the control group (hazard ratio [HR], 0.59 [95% CI, 0.45–0.77]). Patients on combination therapy had the lowest risk (HR, 0.46 [95% CI, 0.31–0.69]). Conclusions Patients with high right ventricular pacing burden who received ACEI, ARB, or BB within 10 years of pacemaker implantation had a lower incidence of PICM. |
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| ISSN: | 2047-9980 |