Independent predictors of a positive response to pacemaker implantation in patients with chronic heart failure

Abstract

Introduction. Over the past decades, an increase in mortality from chronic heart failure has been recorded, for the treatment of which the implantation of a pacemaker can be used. The implanted pacemaker expands the possibilities of drug therapy, but requires professional monitoring and titration of the drugs used. Purpose. To determine and evaluate independent predictors of a positive response to permanent pacemaker implantation in patients with chronic heart failure, depending on the presence of type 2 diabetes. Materials and methods. Examined 203 patients with CHF who were inpatient treatment and outpatient examination in the department of ultrasound and clinical and instrumental diagnostics and minimally invasive interventions of the State Institution «V. T. Zaycev Іnstitute of General and Urgent Surgery» and had reasonable indications for implantation of pacemaker. Pacemaker implantation was performed in 102 patients with chronic heart failure with concomitant type 2 diabetes, which made up the main or first group; among the representatives of this group there were 52 people, the average age of the surveyed participants was (67.7 ± 8.3) years. Patients with CHF who also underwent pacemaker implantation, but without comorbid diabetes mellitus (n = 101) were selected as a control group. Results. It was found that the female sex was significantly associated with the absence of response to pacemaker implantation. The influence of the pacemaker regime was determined almost at the established level of confidence, which determined the associations of the DDDR regime with the development of response to treatment. Patients with AV block Mobitz II had significantly higher chances of responding to pacemaker implantation. Analyzing the clinical forms of coronary artery disease, it was found that, compared with patients without coronary artery disease, the presence of stable angina pectoris significantly increased the chances of not responding to implantation. Stronger influence was exerted by the presence of cardiosclerosis of any genesis. Findings. The obtained independent predictors allow an early assessment of the success of cardiac pacing in patients with CHF, which can prevent unwanted consequences or conduct preliminary prophylaxis in order to improve the response to pacemaker implantation in such patients.