TOPLINE:

Left ventricular systolic dysfunction (LVSD) was common in patients receiving right ventricular pacing, and a history of ischaemic heart disease and a high ventricular pacing burden were identified as independent predictors of LVSD. Patients undergoing generator replacement had a higher rate of heart failure-related hospitalisation or death than those receiving a first-time implant.

METHODOLOGY:

• Researchers conducted an observational study to assess the frequency of LVSD and to identify clinical and diagnostic factors associated with LVSD and adverse clinical outcomes in patients undergoing first-time or replacement pacemaker therapy for bradycardia.
• The study prospectively enrolled 1024 patients at a single tertiary centre in the UK, including 514 who underwent first-time right ventricular pacemaker implantation between 2014 and 2017 (mean age, 76 years; 66% men) and 510 who underwent pacemaker generator replacement between 2008 and 2011 (mean age, 76 years; 56% men).
• Patients undergoing first-time pacemaker implantation were offered repeat transthoracic echocardiography and device interrogation at a minimum of 12 months after implantation to assess left ventricular function, left ventricular and left atrial sizes, and ventricular pacing burden.
• The primary outcome was the prevalence of LVSD, defined as a left ventricular ejection fraction (LVEF) below 50%.

TAKEAWAY:

• Overall, LVSD was common, affecting 37% of patients, and a similar prevalence was observed in those undergoing first-time pacemaker implantation and those undergoing pacemaker generator replacement (35% vs 32%; P = .21).
• After adjustment for clinical factors, a history of ischaemic heart disease and a ventricular pacing burden above 80% were independently associated with more than 2.5-fold and approximately twofold increased odds of LVSD, respectively (P ≤ .01 for both).
• Over a median follow-up duration of 30 months, 33% of patients experienced heart failure-related hospitalisation or death, with events occurring more frequently in patients undergoing pacemaker generator replacement than in those undergoing first-time pacemaker implantation (25% vs 8% of patients; P = .02).
• Being older than 80 years, having a history of atrial fibrillation, and having a baseline LVEF below 40% were independent predictors of heart failure-related hospitalisation or death.

IN PRACTICE:

"Together, these observations could help identify a population in whom targeted screening, optimisation of medical therapy, and tailored pacing strategies could be clinically beneficial and an effective use of resource to reduce patient-oriented adverse events," the authors wrote.

SOURCE:

This study was led by Nurul H. Abdul Samad, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, England. It was published online on April 27, 2026, in European Heart Journal - Cardiovascular Pharmacotherapy.

LIMITATIONS:

The study reflected a single-centre experience, which may have limited the generalisability of the findings to other healthcare settings. Patients were recruited from different time periods, which may have affected outcomes due to variations in treatment guidelines, heart failure management, and device programming practices. The observational study design precluded causal inference.

DISCLOSURES:

The study received funding from the National Institute for Health Research and other sources. Some authors disclosed receiving speaker's fees, honoraria, non-financial support, unconditional research grants, and unrestricted research awards from various companies. The authors declared having no competing interests.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.