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Long-term performance of right ventricular pacing leads: risk factors associated with permanent right ventricular pacing threshold increase.

Authors
  • Peng, Hui1
  • Sun, Zhijun2
  • Zhang, Heping2
  • Ma, Wenying2
  • 1 Section of Electrophysiology, Division of Cardiology, Beijing Friendship Hospital Affiliated to Capital Medical University, No. 95 Yongan Road, Xi-cheng District, Beijing, 100050, China. [email protected] , (China)
  • 2 Section of Electrophysiology, Division of Cardiology, Beijing Friendship Hospital Affiliated to Capital Medical University, No. 95 Yongan Road, Xi-cheng District, Beijing, 100050, China. , (China)
Type
Published Article
Journal
Journal of Interventional Cardiac Electrophysiology
Publisher
Springer-Verlag
Publication Date
Sep 01, 2019
Volume
55
Issue
3
Pages
349–357
Identifiers
DOI: 10.1007/s10840-018-0481-5
PMID: 30402790
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

Right ventricular pacing threshold (RVPT) may rise over time accompanied by the increased use of implantable cardiac pacemakers. However, risk factors for permanent RVPT increase are not fully clarified in patients without definite lead fracture and dislodgment. We aimed to evaluate the long-term performance of RV pacing leads and identify risk factors associated with the occurrence of permanent RVPT increase in this population. Patients with first implantation of cardiac pacemakers from January 2008 to June 2016 were consecutively enrolled. Follow-up for RVPT increase was until December 2017. The clinical data, specific data on the pacemaker implantation, and routine follow-up were retrieved. During a follow-up duration of 5.4 ± 2.1 years, permanent RVPT increase (except lead fracture and dislodgment) was found in 8.4% (87/1033) patients. Patients with permanent RVPT increase had higher prevalence of myocardial infarction (MI), diabetes, and the use of amiodarone. The risk factors independently associated with permanent RVPT increase were MI (HR = 1.094, 95% CI 1.014-1.180, p = 0.031), diabetes (HR = 2.804, 95% CI 1.064-3.775, p = 0.003). MI patients with RVPT increase had higher prevalence of multivessel disease and atrioventricular block. Diabetic patients with RVPT increase exhibited higher serum fasting blood glucose (FBG) and hemoglobin A1c (HbA1c) levels, which were correlated with the maximum RVPT (p < 0.001). Our data showed that permanent RVPT increases (except lead fracture and dislodgement) during long-term follow-up after pacemaker implantation. The likely risk factors predisposing to chronic permanent RVPT increase are MI and diabetes with higher FBG and HbA1c levels.

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