The prevalence of heart failure and asymptomatic left ventricular systolic dysfunction in a typical regional pacemaker population

• Published in: European heart journal Vol. 24; no. 12; pp. 1143 - 1152
• Main Authors: Thackray, Simon D.R., Witte, Klaus K.A., Nikitin, Nikolay P., Clark, Andrew L., Kaye, Gerald C., Cleland, John G.F.
• Format: Journal Article
• Language: English
• Published: Oxford Oxford University Press 01-06-2003
• Subjects: Adult; Aged; Aged, 80 and over; Atrial Fibrillation - therapy; Biological and medical sciences; Blood Flow Velocity; Cardiac Output, Low - diagnosis; Cardiac Pacing, Artificial; Cardiology. Vascular system; Cardiovascular Agents - therapeutic use; Diabetic Angiopathies - complications; Double-Blind Method; Dyspnea - etiology; Echocardiography; Exercise Tolerance; Fatigue - etiology; Female; Heart; Heart failure; Heart failure, cardiogenic pulmonary edema, cardiac enlargement; Humans; Male; Medical sciences; Middle Aged; Pacemaker syndrome; Pacemakers; Risk Factors; Stroke Volume - physiology; Ventricular Dysfunction, Left - diagnosis; Heart; Sonography; Heart failure; Echocardiography; Prevalence; Instrumentation therapy; Cardiovascular disease; Heart ventricle; Asymptomatic; Left ventricular failure; Regional; Epidemiology; Phlebology; Syndrome; Instrumental stimulation; Pacemaker; Heart disease; Population; Circulatory system; Cardiology; Left ventricle performance; Pacemakers; Pacemaker syndrome; Echocardiography
• ISSN: 0195-668X; 1522-9645
• DOI: 10.1016/S0195-668X(03)00199-4

Aims To assess the prevalence of heart failure and asymptomatic left ventricular systolic dysfunction in the chronically paced population. Methods and Results Three hundred and seven patients were identified from attendance at routine pacemaker follow-up clinic. Subjects underwent a medical history and examination, 6-minute walk test and echocardiography. 94 (31%) had a left ventricular ejection fraction (LVEF) <40%, of whom 83 had symptoms of heart failure (70% NYHA II, 26% NYHA III and 4% NYHA IV). Heart failure was more prevalent in patients with single chamber compared to dual chamber pacemakers, (DDD(R) 18% vs 35% VVI(R), p<0.008), and those with chronic atrial fibrillation (AF) compared to those with sinus rhythm (42% vs 21%, p=0.003). Decreasing 6-minute walk distance, history of ischaemic heart disease and years of pacing were independently associated with the presence of heart failure (combined R=0.572, p<0.001). Conclusions Heart failure due to left ventricular systolic dysfunction is common in the paced population. Only a minority of these had a pre-existing diagnosis and a smaller proportion were on ‘optimal’ therapy. Echocardiographic screening of this high-risk population is justified to improve rates of diagnosis and treatment of heart failure.