title: Presence of structural heart disease and left ventricular dysfunction predict hospitalizations for new-onset heart failure after right ventricular apical pacing.
abstract: OBJECTIVE
  Long-standing right ventricular apical pacing (RVAP) may result in impaired left ventricular (LV) function and systolic heart failure (HF) in selected patients. However, which patients are susceptible to those harmful effects is unknown.
  
  
  RESULTS
  In 367 consecutive patients undergoing pacemaker implantations (PMIs) and RVAP, the clinical, laboratory, and echocardiographic data before the PMIs, electrocardiographic parameters [baseline and paced QRS duration (QRSd)], and echocardiography were analysed. The cumulative per cent of those ventricularly paced (Cum%VP) was >90% in all subjects. During a mean follow-up period of 113±69 months, the occurrence of HF requiring hospitalization for the intravenous administration of HF medications was found in 60 patients (16%; HF group), but not in the remaining 307 (84%; no-HF group). The prevalence of structural heart disease (SHD; P<0.0001), cardiothoracic ratio (P<0.0001), baseline left atrial size (P=0.0001), LV end-diastolic volume (P<0.005) and end-systolic volume (P<0.0005), LV mass index (P<0.001), and baseline and paced QRSd (both for P<0.001) were greater in the HF group than in the no-HF group. Inversely, the LV ejection fraction (LVEF) in the HF group was smaller than that in the no-HF group (P<0.001). The multivariate Cox regression analysis revealed that the presence of SHD [hazard ratio (HR)=3.12; 95% confidence interval (CI), 1.7-5.7; P<0.001] and the LVEF (<40%; HR=2.57; 95% CI, 1.09-6.07; P<0.05) were associated with hospitalizations due to HF after RVAP.
  
  
  CONCLUSIONS
  The presence of SHD and an impaired LV systolic function before the PMI may predict hospitalizations due to HF after RVAP.
authors.affiliation: Department of Cardiovascular Science and Medicine, Chiba University, Chiba, Japan.
authors.forename: Yasuhiko
authors.initials: Y
authors.lastname: Hori
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Tada
authors.forename: Kouki
authors.initials: K
authors.lastname: Nakamura
authors.forename: Shigeto
authors.initials: S
authors.lastname: Naito
authors.forename: Yoshio
authors.initials: Y
authors.lastname: Nakata
authors.forename: Koji
authors.initials: K
authors.lastname: Goto
authors.forename: Jotaro
authors.initials: J
authors.lastname: Imamoto
authors.forename: Miki
authors.initials: M
authors.lastname: Yokokawa
authors.forename: Yasuaki
authors.initials: Y
authors.lastname: Tanaka
authors.forename: Nobusada
authors.initials: N
authors.lastname: Funabashi
authors.forename: Kazutaka
authors.initials: K
authors.lastname: Aonuma
authors.forename: Issei
authors.initials: I
authors.lastname: Komuro
authors.forename: Koichi
authors.initials: K
authors.lastname: Taniguchi
authors.forename: Shigeru
authors.initials: S
authors.lastname: Oshima
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D058406:Cardiac Resynchronization Therapy / Q000009:adverse effects*; D004452:Echocardiography; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006331:Heart Diseases / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D006333:Heart Failure / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D015995:Prevalence; D012044:Regression Analysis; D012189:Retrospective Studies; D013318:Stroke Volume / Q000502:physiology; D018487:Ventricular Dysfunction, Left / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D018497:Ventricular Dysfunction, Right / Q000503:physiopathology / Q000628:therapy*