Abstract 17644: A Paced QRS Duration Could Predict the New-onset Congestive Heart Failure After Permanent Right Ventricular Apical Pacing in Patients With Acquired High-grade Atrioventricular Block and Normal Left Ventricular Function
Purpose: The right ventricular (RV) apical pacing results in progressive left ventricular (LV) dysfunction and contributes to the development of heart failure (HF). In MOST and DAVID trials, increased heart failure hospitalization was associated with the prevalence of more than 40% RV pacing. This study aimed to investigate the prevalence and clinical predictors for the development of the new-onset congestive heart failure (CHF) after long-term RV apical pacing in patients with acquired atrioventricular (AV) block who require permanent pacing.
Methods: We studied the clinical outcomes after long-term (>90% ventricular pacing during more than 1 year) RV apical pacing for acquired AV block in 233 patients without a LV systolic dysfunction (ejection fraction (EF) >50%). We compared age, sex, history of diabetes, hypertension and coronary artery disease, paced QRS duration and echocardiographic parameters between LV systolic dysfunction and normal LV systolic function. The CHF was defined as elevated serum pro-BNP level (more than 700 pg/dL) or CHF hospitalization.
Results: The mean follow up duration was 76 months. The permanent RV apical pacing was associated with the new-onset CHF in 42 patients (18 %) with high degree AV block. In multivariate analysis, after adjusting age, sex, LV EF, the history of hypertension and CAD, pacing duration, and medication, a paced QRS duration could independently predict the new-onset CHF. A paced QRS duration more than 162 msec might help us to predict the new onset CHF.
Conclusions: A paced QRS duration might be associated with the new-onset CHF after permanent RV apical pacing in patients with high degree AV block. So, we try to decrease the paced QRS duration in permanent RV apical pacing.
- © 2013 by American Heart Association, Inc.