title: Pacing-induced cardiomyopathy: pathophysiological insights through matrix metalloproteinases.
abstract: Pacing-induced ventricular dysfunction and pacing-induced cardiomyopathy (PiCMP) are recognized complications of chronic right ventricular pacing. Alterations in myocardial perfusion and sympathetic innervation contribute to the development of pacing-induced heart disease. However, it is unlikely that these are the only processes involved. Matrix metalloproteinases (MMPs) are proteolytic enzymes that degrade the collagenous extracellular matrix and play a central role in left ventricular remodelling during the development of heart failure. While the pathophysiological mechanisms and altered MMP expression that occur in chronic pressure overload, ischaemic and non-ischaemic dilated cardiomyopathy have been defined, those that occur in the clinical setting of pacing-induced ventricular dysfunction and PiCMP have not been reported. Here we review the clinical epidemiology of pacing-induced ventricular dysfunction and discuss how data derived from animal models provide insight into how changes in MMP expression and function contribute to the development of PiCMP. The review concludes by exploring pacing strategies that may be used to prevent pacing-induced ventricular dysfunction.
authors.affiliation: Manchester Heart Centre, Manchester Royal Infirmary, Oxford Road, Manchester, M13 9WL, UK, foziaahmed@doctors.org.uk.
authors.forename: Fozia Z
authors.initials: FZ
authors.lastname: Ahmed
authors.forename: Rajdeep S
authors.initials: RS
authors.lastname: Khattar
authors.forename: Amir M
authors.initials: AM
authors.lastname: Zaidi
authors.forename: Ludwig
authors.initials: L
authors.lastname: Neyses
authors.forename: Delvac
authors.initials: D
authors.lastname: Oceandy
authors.forename: Mamas
authors.initials: M
authors.lastname: Mamas
mesh_terms: D000818:Animals; D002304:Cardiac Pacing, Artificial; D006333:Heart Failure / Q000201:enzymology* / Q000503:physiopathology; D006352:Heart Ventricles / Q000503:physiopathology*; D006801:Humans; D020782:Matrix Metalloproteinases / Q000378:metabolism*; D018487:Ventricular Dysfunction, Left / Q000201:enzymology* / Q000503:physiopathology; D020257:Ventricular Remodeling / Q000502:physiology
chemical_list: D020782:Matrix Metalloproteinases