March20, 2023

Abstract Volume: 4 Issue: 3 ISSN:

Risk Factors for LVEF Alteration linked to Apical Stimulation: Monocentric Retrospective Study

Dr M Belhameche*, Dr N Zarouf1, Dr S Sioua2, Dr S Naccache3, Dr A Salhi4, Dr A Kovalchuk5Dr An Chaib6, Dr H Bouzelmat7


1,2,3,4,5. GHEF Marne le vallée Rhythmology Unit.

6,7. Military hospital mohamed V Rabat.

Corresponding Author: Dr M Belhameche, GHEF Marne le vallée Rhythmology Unit.

Copy Right: © 2022 Dr M Belhameche, this is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Received Date: March 25, 2022

Published Date: April 01, 2022



Background: The aim of our retrospective study is to see what are the risk factors that can induce an alteration of left ventricular function (LVEF) in patients implanted with a Pacemaker with apical stimulation for conduction disorder.

Method: We implanted 520 patients between January 2019 and December 2020. We carried out the follow-up of 172 patients with an LVEF greater than 45%. The average follow-up is 18 months by echocardiography at 6, 12 and 18 months. We observed an alteration of LVEF in 43 patients, and compared these patients to the other 129 patients to see if there are any risk factors that may induce an alteration in LVEF.

Results43 patients altered their LVEF during follow-up, representing 8.7% of the population of 520.

The mean time to onset of LVEF impairment was 6 months, sometimes with signs of heart failure requiring hospitalization. We ruled out any other pathology at the origin of this alteration in contractile function.The identified risk factors are: -Age, Ischemic cardiomyopathy, LVEF, Percent of pacing, Kidney failure.

Key Words.  Apical pacing (AP), risks factors (RF), Left ventricular fraction ejection ( LVEF), Arhythmic cardiomyopathy (AC), Pacemaker (PM) , Upgrade pacing, Non upgrade pacing.

Risk Factors for LVEF Alteration linked to Apical Stimulation: Monocentric Retrospective Study

Concept of Asynchronism

  • We know that there are arhythmic heart disease.
  • And we know from Cazeau’s study the deleterious and aggravating effect of the existence of a left bundle branch block or of the apical stimulation.
  • We will conclude that the apical RV pacing can lead to arhythmic heart disease.


Retrospective study.

  • We have implanted 520 patients by Pacemaker (PM) between January 2019 and December 2020.
  • We screened 172 patients who had a cardiac ultrasound before PM implantation at 6,12, and 18 months
  • We observe that they have 43 out of 520 (8,2%) patients who required an Up-grading PM due to the alteration of their left ventricular function (LVFE) with heart failure chart.
  • We tried to find out if there are risk factors that facilitate the alteration of LVEF.


  • We have identified 5 risk factors for alteration of LVEF:
  • Age
  • Ischemic cardiomyopathy
  • Left ventricular ejection fraction.
  • Percent pacing.
  • Renal failure.

Study limitations

  • Reviews:
  • Single-center retrospective study.
  • Implantation of 520 but followed by 172. And 43 patients who required Up-grade this following 8,2%.
  • Medical treatment is not the same because of a population is very different.


the interest of this study, even if it is monocentric and retrospective, is to show the risk factors that can contribute to the evolution towards a rhythmic heart disease in the event of apical stimulation by a pacemaker.

Numerous studies have shown the deleterious effect of apical stimulation but have not specified the risk factors towards this development.

Neither do the ESC recommendations. They recommend with a level IIa for a CRT only in case of LVEF < 40% and a rate of RV stimulation > 20% (this would be related to the CMRs induced by an ESV rate > 20%).

I think it is important that there are other larger and prospective studies to further clarify the factors likely to favor the evolution towards CMR.



The interest of this work is to have highlighted certain factors such as age, ischemic CM, LVEF, RV stimulation rate and renal failure. This avoids taking a patient for an Up grading



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