Schrittmacherabhängigkeit bei Patienten nach Herzschrittmacherimplantation

Although several millions of pacemakers have been implanted worldwide in the last 50 years, data on the prevalence and predictors for the development of pacing-dependency in patients with permanent pacemaker or implantable cardioverter defibrillator are sparse. Therefore, pacing-dependency defined as absence of an intrinsic rhythm ≥ 30 bpm was determined in 802 consecutive patients who visited our pacemaker or implantable cardioverter-defibrillator outpatient clinic for routine follow-up. As a result, 131 of 802 patients (16%) were found to be pacing-dependent 67±70 months after implant. Multivariate analysis revealed a significant association between pacing-dependency and the following clinical variables: • AV block grade 2 or 3 at implant (OR = 19.9; 95% CI: 10.9 – 38.5, p<0.01) • atrial fibrillation at implant (OR = 2.15; 95% CI: 1.16 – 4.05, p=0.02) • left ventricular ejection fraction ≤30% (OR = 2.06; 95% CI: 1.03 – 4.15, p=0.04) • brain natriuretic peptide >150 pg/ml (OR = 2.12; 95% CI: 1.16 – 3.97, p=0.02) • chronic kidney disease (OR = 1.86; 95% CI = 1.08 – 3.26, p=0.03), and • follow-up duration after implant >5 years (OR = 3.29; 95% CI: 1.96 – 5.64, p<0.01) None of the remaining clinical variables including age, gender, underlying heart disease, prior cardiac surgery or medication during follow-up predicted pacing-dependency. In conclusion, pacing dependency depends on the pacing indication and is much more common in patients with high-degree AV-block at implant compared to patients with sick sinus syndrome. In addition, pacing dependency is associated with more advanced heart failure, chronic kidney disease and follow-up duration after implant. Since pacing dependent patients who suffer from heart failure will need frequent ventricular pacing, physiological pacing using His bundle stimulation or biventricular stimulation should be considered in these patients.