Effect of Right Ventricular Apical Pacing in Survivors of Myocardial Infarction

Background: Much information is available regarding the possible negative effects of long‐term right ventricular (RV) apical pacing, which may cause worsening of heart failure. However, very limited data are available regarding the effects of RV pacing in patients with a previous myocardial infarction (MI). Methods and Results: We screened 115 consecutive post‐MI patients and matched a group of 29 pacemaker (PM) recipients with a group of 49 unpaced patients, for age, left ventricular (LV) ejection fraction, and site of MI. During a median follow‐up of 54 months, echocardiograms showed a decrease in LV ejection fraction in the paced group, from 51 ± 10 to 39 ± 11 (P < 0.01), and a minimal change in the unpaced group, from 57 ± 8 to 56 ± 7 (P = 0.98). Similar change was observed in systolic and diastolic diameters and volumes. Conclusions: The study showed that, in post‐MI patients, RV apical pacing was associated with a worsening of LV function, suggesting that, among MI survivors, the need for a PM is a marker of worse outcome.