AIMS: The objective of the current study is to investigate the risk of heart failure (HF) after implantation of a pacemaker (PM) with a right ventricular pacing (RVP) lead in comparison to a matched cohort without a PM and factors associated with this risk.
METHODS AND RESULTS: All patients without a known history of HF who had a PM implanted with an RVP lead between 2000 and 2014 (n?=?27 704) were identified using Danish nationwide registries. An age- and gender-matched control cohort (matched 1:5, n?=?138 520) without PM and HF was identified to compare the risk. Outcome was the cumulative incidence of HF including fatal HF within the first 2?years of PM implantation, with all-cause mortality and myocardial infarction (MI) as competing risks. Due to violation of proportional hazards, the follow-up period was divided into three time-intervals: <30?days, 30-180?days, and >180?days-2?years. The cumulative incidence of HF including fatal HF was observed in 2937 (10.6%) PM patients. Risks for the three time-intervals were <30?days [hazard ratio (HR) 5.98, 95% CI 5.19-6.90], 30-180?days (HR 1.84, 95% CI 1.71-1.98), and >180?days (HR 1.11, 95% CI 1.04-1.17). Among patients with a PM device, factors associated with increased risk of HF were male sex (HR 1.33, 95% CI 1.24-1.43), presence of chronic kidney disease (CKD) (HR 1.64, 95% CI 1.29-2.09), and prior MI (1.77, 95% 1.50-2.09).
CONCLUSIONS: Pacemaker with an RVP lead is strongly associated with risk of HF specifically within the first 6?months. Patients with antecedent history of MI and CKD had substantially increased risk.