![]() ![]() Decreased LVEF below 40% or an indication to CRT upgrade 7.Decreased LVEF below 45% or a decline in LVEF that is greater than 10% after PPM implantation 12.Decreased LVEF by 10% or more or below 50% regardless of patient symptoms 8,11.The authors’ review of published research found these were the four most frequent PICM definitions: The current literature has several working sets of diagnostic criteria for identifying PICM, primarily based on changes in the LVEF ( Table 1). This condition is known as pacing-induced cardiomyopathy (PICM). In some of them, left ventricular ejection fraction (LVEF) can decline after pacing. 2Įven though PPMs brought indisputable benefits to patients with bradycardia, the constantly rising standards for patient wellbeing and better patient follow-up have revealed patients who fail to tolerate conventional right ventricular (RV) pacing. The increased life expectancies of the steadily growing elderly population have led to increased permanent pacemaker (PPM) implantation rates and new challenges in treating bradycardia. Epicardial leads have been replaced by transvenous leads and pacemakers are programmed to sense underlying cardiac activity and provide pacing only when needed. Pacemaker and lead technology have developed rapidly, and modern pacemakers are now automatic and more reliable. Since the first implantable pacemaker was developed in 1959 by Rune Elmqvist, cardiac pacing has undergone a dynamic technological revolution. ![]() Permanent cardiac pacing is a standard, reliable and widely accessible method of bradycardia treatment. This information can assist the electrophysiologist in selecting a pacing location that avoids dyssynchronous ventricular activation. It can be performed during the implantation procedure to visualise ventricular depolarisation and resultant ventricular dyssynchrony during pacing. However, the ventricular activation sequence can be readily displayed from the chest leads using an ultra-high-frequency ECG. Paced QRS duration is an imperfect marker of dyssynchrony, and methods based on body surface mapping, electrocardiographic imaging or echocardiography are laborious and time-consuming, and can be difficult to use during the implantation procedure. Currently, methods that would allow rapid and reliable ventricular dyssynchrony assessment, ideally during the implant procedure, are lacking. Ventricular dyssynchrony was identified as one of the main factors responsible for pacing-induced cardiomyopathy development. This is a consequence of non-physiological ventricular activation bypassing the conduction system. The majority of patients tolerate right ventricular pacing well however, some patients manifest signs of heart failure after pacemaker implantation and develop pacing-induced cardiomyopathy. ![]()
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