PMID- 38490597
OWN - NLM
STAT- Publisher
LR  - 20240410
IS  - 1556-3871 (Electronic)
IS  - 1547-5271 (Linking)
DP  - 2024 Mar 13
TI  - Risk of malignant ventricular arrhythmias in patients with mildly to moderately 
      reduced ejection fraction after permanent pacemaker implantation.
LID - S1547-5271(24)00271-6 [pii]
LID - 10.1016/j.hrthm.2024.03.026 [doi]
AB  - BACKGROUND: Many patients with mildly to moderately reduced left ventricular 
      ejection fraction (LVEF) who require permanent pacemaker (PPM) implantation do 
      not have a concurrent indication for implantable cardioverter-defibrillator (ICD) 
      therapy. However, the risk of ventricular tachycardia/ventricular fibrillation 
      (VT/VF) in this population is unknown. OBJECTIVE: The aim of this study was to 
      describe the risk of VT/VF after PPM implantation in patients with mildly to 
      moderately reduced LVEF. METHODS: Retrospective analysis was performed of 243 
      patients with LVEF between 35% and 49% who underwent PPM placement and did not 
      meet indications for an ICD. The primary end point was occurrence of sustained 
      VT/VF. Competing risks regression was performed to calculate subhazard ratios for 
      the primary end point. RESULTS: Median follow-up was 27 months; 73% of patients 
      were male, average age was 79 +/- 10 years, average LVEF was 42% +/- 4%, and 70% were 
      New York Heart Association class II or above. Most PPMs were implanted for sick 
      sinus syndrome (34%) or atrioventricular block (50%). Of 243 total patients, 11 
      (4.5%) met the primary end point of VT/VF. Multivessel coronary artery disease 
      (CAD) was associated with significantly higher rates of VT/VF, with a subhazard 
      ratio of 5.4 (95% CI, 1.5-20.1; P = .01). Of patients with multivessel CAD, 8 of 
      82 (9.8%) patients met the primary end point for an annualized risk of 4.3% per 
      year. CONCLUSION: Patients with mildly to moderately reduced LVEF and multivessel 
      CAD undergoing PPM implantation are at increased risk for the development of 
      malignant ventricular arrhythmias. Patients in this population may benefit from 
      additional risk stratification for VT/VF and consideration for upfront ICD 
      implantation.
CI  - Copyright (c) 2024 Heart Rhythm Society. Published by Elsevier Inc. All rights 
      reserved.
FAU - Dai, Matthew
AU  - Dai M
AD  - Leon H. Charney Division of Cardiology, NYU Langone Health, New York, New York.
FAU - Peterson, Connor
AU  - Peterson C
AD  - Leon H. Charney Division of Cardiology, NYU Langone Health, New York, New York.
FAU - Chorin, Udi
AU  - Chorin U
AD  - Department of Cardiology, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel.
FAU - Leiva, Orly
AU  - Leiva O
AD  - Leon H. Charney Division of Cardiology, NYU Langone Health, New York, New York.
FAU - Katz, Moshe
AU  - Katz M
AD  - Leon H. Charney Division of Cardiology, NYU Langone Health, New York, New York.
FAU - Sliman, Hend
AU  - Sliman H
AD  - Department of Cardiology, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel.
FAU - Aizer, Anthony
AU  - Aizer A
AD  - Leon H. Charney Division of Cardiology, NYU Langone Health, New York, New York.
FAU - Barbhaiya, Chirag
AU  - Barbhaiya C
AD  - Leon H. Charney Division of Cardiology, NYU Langone Health, New York, New York.
FAU - Bernstein, Scott
AU  - Bernstein S
AD  - Leon H. Charney Division of Cardiology, NYU Langone Health, New York, New York.
FAU - Holmes, Douglas
AU  - Holmes D
AD  - Leon H. Charney Division of Cardiology, NYU Langone Health, New York, New York.
FAU - Knotts, Robert
AU  - Knotts R
AD  - Leon H. Charney Division of Cardiology, NYU Langone Health, New York, New York.
FAU - Park, David
AU  - Park D
AD  - Leon H. Charney Division of Cardiology, NYU Langone Health, New York, New York.
FAU - Spinelli, Michael
AU  - Spinelli M
AD  - Leon H. Charney Division of Cardiology, NYU Langone Health, New York, New York.
FAU - Chinitz, Larry
AU  - Chinitz L
AD  - Leon H. Charney Division of Cardiology, NYU Langone Health, New York, New York.
FAU - Jankelson, Lior
AU  - Jankelson L
AD  - Leon H. Charney Division of Cardiology, NYU Langone Health, New York, New York. 
      Electronic address: Lior.Jankelson@nyulangone.org.
LA  - eng
PT  - Journal Article
DEP - 20240313
PL  - United States
TA  - Heart Rhythm
JT  - Heart rhythm
JID - 101200317
SB  - IM
OTO - NOTNLM
OT  - Coronary artery disease
OT  - HFmrEF
OT  - Heart failure
OT  - ICD
OT  - PPM
OT  - Ventricular arrhythmias
COIS- Disclosures The authors have no conflicts of interest to disclose.
EDAT- 2024/03/16 05:42
MHDA- 2024/03/16 05:42
CRDT- 2024/03/15 20:33
PHST- 2024/01/08 00:00 [received]
PHST- 2024/02/22 00:00 [revised]
PHST- 2024/03/10 00:00 [accepted]
PHST- 2024/03/16 05:42 [pubmed]
PHST- 2024/03/16 05:42 [medline]
PHST- 2024/03/15 20:33 [entrez]
AID - S1547-5271(24)00271-6 [pii]
AID - 10.1016/j.hrthm.2024.03.026 [doi]
PST - aheadofprint
SO  - Heart Rhythm. 2024 Mar 13:S1547-5271(24)00271-6. doi: 
      10.1016/j.hrthm.2024.03.026.