Combined impact of paced QRS duration and right ventricular pacing burden on heart failure admission: Identifying clinical progression to stage C/D in pacemaker recipients.
- 1Department of Cardiology, Yamaguchi Prefectural Grand Medical Center, Hofu, Japan.
- 2Department of Clinical Engineering, Yamaguchi Prefectural Grand Medical Center, Hofu, Japan.
Abstract
Background
Right ventricular (RV) pacing-induced dyssynchrony can lead to progressive left ventricular (LV) dysfunction. Although a decline in LV ejection fraction (LVEF) after pacemaker implantation is common, the transition to symptomatic heart failure (HF) requiring hospitalization (HF admission [HFA]) represents a more clinically meaningful progression to stages C/D.Objective
To determine whether paced QRS (pQRS) duration and RV pacing (RVp) burden independently or jointly predict HFA in pacemaker recipients followed with remote monitoring.Methods
We retrospectively analyzed 200 pacemaker recipients actively followed with remote monitoring. pQRS at implantation and RVp during follow-up were evaluated as markers of baseline electrical dyssynchrony and cumulative pacing exposure. The primary endpoint was HFA, whereas the secondary endpoint was all-cause mortality.Results
During a median follow-up of 4.5 years, 27 patients (13.5%) developed HFA. Patients with HFA had longer pQRS (171 ± 18 vs 156 ± 20 ms, P < .001) and higher RVp (median 99% vs 38%, P = .002). In a multivariable Cox model, both pQRS of ≥168 ms (hazard ratio, 2.98, P = .011) and RVp of ≥20% (hazard ratio, 7.16, P = .009) and age independently predicted HFA. Neither pQRS nor RVp predicted all-cause mortality, which was associated only with age.Conclusion
pQRS and RVp jointly identify patients at high risk of progression from clinical to symptomatic HF (stages C/D). Although mortality in this population is primarily age-driven, HFA reflects a modifiable consequence of pacing-related dyssynchrony. Combined assessment of pQRS and RVp may facilitate early identification of high-risk patients who could benefit from closer monitoring or alternative pacing strategies.
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BibTeX
@article{ueyama2026combined,
title = {{Combined impact of paced QRS duration and right ventricular pacing burden on heart failure admission: Identifying clinical progression to stage C/D in pacemaker recipients.}},
author = {Takeshi Ueyama and Shoya Sugita and Masaaki Yoshida and Tomoyuki Uchida and Yufuko Nishida and Chihiro Yamada and Fumiaki Nakao and Yasuhiro Ikeda},
journal = {Heart rhythm O2},
year = {2026},
month = jul,
doi = {10.1016/j.hroo.2026.07.013},
url = {https://europepmc.org/article/MED/42936091},
note = {CC BY},
}
RIS
TY - JOUR
TI - Combined impact of paced QRS duration and right ventricular pacing burden on heart failure admission: Identifying clinical progression to stage C/D in pacemaker recipients.
AU - Takeshi Ueyama
AU - Shoya Sugita
AU - Masaaki Yoshida
AU - Tomoyuki Uchida
AU - Yufuko Nishida
AU - Chihiro Yamada
AU - Fumiaki Nakao
AU - Yasuhiro Ikeda
PY - 2026
DA - 2026/07/21
JO - Heart rhythm O2
DO - 10.1016/j.hroo.2026.07.013
UR - https://europepmc.org/article/MED/42936091
AB - Background Right ventricular (RV) pacing-induced dyssynchrony can lead to progressive left ventricular (LV) dysfunction. Although a decline in LV ejection fraction (LVEF) after pacemaker implantation is common, the transition to symptomatic heart failure (HF) requiring hospitalization (HF admission [HFA]) represents a more clinically meaningful progression to stages C/D.Objective To determine whether paced QRS (pQRS) duration and RV pacing (RVp) burden independently or jointly predict HFA in pacemaker recipients followed with remote monitoring.Methods We retrospectively analyzed 200 pacemaker recipients actively followed with remote monitoring. pQRS at implantation and RVp during follow-up were evaluated as markers of baseline electrical dyssynchrony and cumulative pacing exposure. The primary endpoint was HFA, whereas the secondary endpoint was all-cause mortality.Results During a median follow-up of 4.5 years, 27 patients (13.5%) developed HFA. Patients with HFA had longer pQRS (171 ± 18 vs 156 ± 20 ms, P < .001) and higher RVp (median 99% vs 38%, P = .002). In a multivariable Cox model, both pQRS of ≥168 ms (hazard ratio, 2.98, P = .011) and RVp of ≥20% (hazard ratio, 7.16, P = .009) and age independently predicted HFA. Neither pQRS nor RVp predicted all-cause mortality, which was associated only with age.Conclusion pQRS and RVp jointly identify patients at high risk of progression from clinical to symptomatic HF (stages C/D). Although mortality in this population is primarily age-driven, HFA reflects a modifiable consequence of pacing-related dyssynchrony. Combined assessment of pQRS and RVp may facilitate early identification of high-risk patients who could benefit from closer monitoring or alternative pacing strategies.
SN - 2666-5018
ER -