title: The prevalence of heart failure and asymptomatic left ventricular systolic dysfunction in a typical regional pacemaker population.
abstract: OBJECTIVE
  To assess the prevalence of heart failure and asymptomatic left ventricular systolic dysfunction in the chronically paced population.
  
  
  RESULTS
  Three hundred and seven patients were identified from attendance at routine pacemaker follow-up clinic. Subjects underwent a medical history and examination, 6-minute walk test and echocardiography. 94 (31%) had a left ventricular ejection fraction (LVEF) <40%, of whom 83 had symptoms of heart failure (70% NYHA II, 26% NYHA III and 4% NYHA IV). Heart failure was more prevalent in patients with single chamber compared to dual chamber pacemakers, (DDD(R) 18% vs 35% VVI(R), p<0.008), and those with chronic atrial fibrillation (AF) compared to those with sinus rhythm (42% vs 21%, p=0.003). Decreasing 6-minute walk distance, history of ischaemic heart disease and years of pacing were independently associated with the presence of heart failure (combined R=0.572, p<0.001).
  
  
  CONCLUSIONS
  Heart failure due to left ventricular systolic dysfunction is common in the paced population. Only a minority of these had a pre-existing diagnosis and a smaller proportion were on 'optimal' therapy. Echocardiographic screening of this high-risk population is justified to improve rates of diagnosis and treatment of heart failure.
authors.affiliation: Castle Hill Hospital, University of Hull, Cottingham, Hull, UK. simonthackery@hotmail.com
authors.forename: Simon D R
authors.initials: SD
authors.lastname: Thackray
authors.forename: Klaus K A
authors.initials: KK
authors.lastname: Witte
authors.forename: Nikolay P
authors.initials: NP
authors.lastname: Nikitin
authors.forename: Andrew L
authors.initials: AL
authors.lastname: Clark
authors.forename: Gerald C
authors.initials: GC
authors.lastname: Kaye
authors.forename: John G F
authors.initials: JG
authors.lastname: Cleland
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000628:therapy; D001783:Blood Flow Velocity; D002303:Cardiac Output, Low / Q000175:diagnosis*; D002304:Cardiac Pacing, Artificial; D002317:Cardiovascular Agents / Q000627:therapeutic use; D003925:Diabetic Angiopathies / Q000150:complications; D004311:Double-Blind Method; D004417:Dyspnea / Q000209:etiology; D004452:Echocardiography; D017079:Exercise Tolerance; D005221:Fatigue / Q000209:etiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D013318:Stroke Volume / Q000502:physiology; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis*
chemical_list: D002317:Cardiovascular Agents