title: Late deterioration of left ventricular function after right ventricular pacemaker implantation.
abstract: Right ventricular (RV) pacing induces a left bundle branch block pattern on ECG and may promote heart failure. Patients with dual chamber pacemakers (DCPs) who present with progressive reduction in left ventricular ejection fraction (LVEF) secondary to RV pacing are candidates for cardiac resynchronization therapy (CRT). This study analyzes whether upgrading DCP to CRT with the additional implantation of a left ventricular (LV) lead improves LV function in patients with reduced LVEF following DCP implantation.
  
  
  
  Twenty-two patients (13 males) implanted with DCPs and a high RV pacing percentage (>90%) were evaluated in term of new-onset heart failure symptoms. The patients were enrolled in this retrospective single-center study after obvious causes for a reduced LVEF were excluded with echocardiography and coronary angiography. In all patients, DCPs were then upgraded to biventricular devices. LVEF was analyzed with a two-sided t-test. QRS duration and brain natriuretic peptide (BNP) levels were analyzed with the unpaired t-test.
  
  
  
  LVEF declined after DCP implantation from 54±10% to 31±7%, and the mean QRS duration was 161±20 ms during RV pacing. NT-pro BNP levels were elevated (3365±11436 pmol/L). After upgrading to a biventricular device, a biventricular pacing percentage of 98.1±2% was achieved. QRS duration decreased to 108±16 ms and 106±20 ms after 1 and 6 months, respectively. There was a significant increase in LVEF to 38±8% and 41±11% and a decrease in NT-pro BNP levels to 3088±2326 pmol/L and 1860±1838 pmol/L at 1 and 6 months, respectively.
  
  
  
  Upgrading to CRT may be beneficial in patients with DCPs and heart failure induced by a high RV pacing percentage.
authors.affiliation: Department of Cardiology, Charité Berlin Campus Benjamin Franklin, Berlin-Germany; Department of Cardiology, University Hospital Aachen RWTH, Aachen-Germany. barbara.bellmann@charite.de.
authors.forename: Barbara
authors.initials: B
authors.lastname: Bellmann
authors.affiliation: Department of Cardiology, Charité Berlin Campus Benjamin Franklin, Berlin-Germany.
authors.forename: Bogdan G
authors.initials: BG
authors.lastname: Muntean
authors.affiliation: Heartcare Victoria-Australia.
authors.forename: Tina
authors.initials: T
authors.lastname: Lin
authors.affiliation: Department of Cardiology, University Hospital Aachen RWTH, Aachen-Germany; Department of Cardiology, University Hospital Gießen, Gießen-Germany.
authors.forename: Christopher
authors.initials: C
authors.lastname: Gemein
authors.affiliation: Department of Cardiology, University Hospital Aachen RWTH, Aachen-Germany.
authors.forename: Kathrin
authors.initials: K
authors.lastname: Schmitz
authors.affiliation: Department of Cardiology, University Hospital Aachen RWTH, Aachen-Germany; Kardiologie an der Rudower Chaussee, Berlin-Germany.
authors.forename: Patrick
authors.initials: P
authors.lastname: Schauerte
mesh_terms: D000368:Aged; D002304:Cardiac Pacing, Artificial; D005260:Female; D006333:Heart Failure; D006352:Heart Ventricles / Q000503:physiopathology; D006801:Humans; D008297:Male; D010138:Pacemaker, Artificial; D012189:Retrospective Studies; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left; D016277:Ventricular Function, Left