title: Incidence and predictors of heart failure hospitalization and death in permanent pacemaker patients: a single-centre experience over medium-term follow-up.
abstract: OBJECTIVE
  The aim of this study was to assess the incidence and clinical predictors of the development of new-onset heart failure (HF) over medium-term follow-up, in patients treated with permanent pacing in daily clinical practice.
  
  
  RESULTS
  We retrospectively enrolled all consecutive patients who underwent single- or dual-chamber pacemaker implantation at the study centre. Patients with a left ventricular ejection fraction (LVEF) ≤35% or a prior diagnosis of HF were excluded. Ventricular leads were routinely implanted in the right apex. Pacemakers were implanted in 490 patients with a standard pacemaker indication and LVEF >35%. Left bundle-branch block (LBBB) was reported in 30 (8%) patients, and an LVEF <50% in 64 (13%) patients. During a follow-up of 27 ± 21 months, 32 (7%) patients reached the combined endpoint of HF death or hospitalization. On multivariate analysis, LBBB (HR, 3.50; 95% CI, 1.1-11.1; P = 0.033) and LVEF <50% (HR, 5.1; 95% CI, 1.9-14.2; P = 0.002) were confirmed as independent predictors of HF death or hospitalization. Patients with LVEF <50% and/or LBBB displayed significantly higher rates of HF death or hospitalization (log-rank test, all P<0.001).
  
  
  CONCLUSIONS
  The majority of patients with a standard indication for permanent pacing and normal LV function remained in a clinically stable condition after pacemaker implantation. However, ∼7% of patients developed new-onset HF over a period of follow-up of 27 months, and the presence of LBBB and LVEF <50% at the baseline predicted HF death or hospitalization.
authors: Cardiology Division, Santa Maria della Stella Hospital, Località Ciconia, 05018 Orvieto TR, Italy. and.mazza_m@libero.it
authors: Andrea
authors: A
authors: Mazza
authors: Maria Grazia
authors: MG
authors: Bendini
authors: Massimo
authors: M
authors: Leggio
authors: Umberto
authors: U
authors: Riva
authors: Carmine
authors: C
authors: Ciardiello
authors: Sergio
authors: S
authors: Valsecchi
authors: Raffaele
authors: R
authors: De Cristofaro
authors: Giampiero
authors: G
authors: Giordano
mesh_terms: D017677:Age Distribution; D000368:Aged; D002304:Cardiac Pacing, Artificial / Q000401:mortality*; D005260:Female; D006333:Heart Failure / Q000401:mortality* / Q000517:prevention & control*; D017052:Hospital Mortality; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D010138:Pacemaker, Artificial / Q000706:statistics & numerical data*; D015995:Prevalence; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D017678:Sex Distribution; D015996:Survival Rate; D016896:Treatment Outcome
keywords: Heart failure; Hospitalization; Mortality; Pacemaker