ArticleJACC. Advances2025
Right Ventricular Apical Pacing in Patients With Preserved LVEF: Adverse Effects and Mechanisms.
Article in JACC. Advances, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers, 1 of them a synthesis that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Who cites it
3 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Pacing-Induced Cardiomyopathy in Leadless and Transvenous Pacemakers: A Meta-Analysis and Meta-Regression.Pacing and clinical electrophysiology : PACE · 2026Pooled it
- Association of SGLT2 Inhibitor Use with All-Cause Mortality Following CIED Implantation for Conduction Disease in Patients with Preserved LVEF: A Retrospective Cohort Study.Journal of clinical medicine · 2026Article
- Advanced Cardiac Imaging for Risk Prediction of Pacing-Induced Cardiomyopathy: A Narrative Literature Review.Journal of clinical medicine · 2026Review
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Authors and funding
7 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundLong-term adverse cardiac effects of right ventricular (RV) pacing in patients with normal left ventricular (LV) ejection fraction (EF) are not well studied.
objectivesThe purpose of this study was to evaluate adverse effects of RV apical pacing in patients with normal LVEF.
methodsMedical records of patients who had undergone RV apical pacemaker implantation for pacing indications and had an LVEF ≥50% were reviewed to determine the effect of RV pacing burden on LV systolic and diastolic function, mechanical dyssynchrony, heart failure hospitalization (HFH), and all-cause mortality.
resultsOf the 875 eligible patients from a single center, 459 patients met the inclusion criteria, 185 had <50% RV, and 274 had ≥50% RV pacing burden over a median 4.98 years (IQR: [3.2, 7.0]) of follow-up. LVEF in the ≥50% pacing group (median 63% [IQR: 58%, 67%]) and <50% group (median 64% [IQR: 60, 67]) decreased to 59.5% (IQR: [51%, 63%]) and 62% (IQR: [55%, 66%]), absolute median decrease 6.0 (IQR: [1, 10]) vs 3.0 (IQR: [4, 10]), P = 0.001 in the 2 groups, respectively. On multivariate analysis, RV pacing ≥50% (OR: 2.44 [95% CI: 1.43-4.16]; P = 0.001), baseline LVEF (HR: 0.95 [95% CI: 0.92-0.98]; P = 0.0008), relative decrease of >10% LVEF (HR: 1.73 [95% CI:1.09-2.75]), baseline E/e' ratio (HR: 1.07 [95% CI: 1.05-1.11]; P < 0.0001), and LV mechanical dyssynchrony by strain imaging performed in 193 subjects (HR: 1.031 [95% CI: 1.012-1.051]; P < 0.001) were predictors of HFH. Baseline mechanical dyssynchrony (HR: 1.024 [95% CI: 1.008-1.04]; P < 0.01), its worsening by 25% (HR: 2.077 [95% CI: 1.109-3.89]; P < 0.03), and baseline E/e' (HR: 1.063 [95% CI: 1.025-1.10]; P < 0.01) were predictors of all-cause mortality.
conclusionsIn patients with normal baseline LVEF, chronic apical RV pacing of ≥50% is associated with worse LV systolic function, LV mechanical dyssynchrony, and increases HFH.
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