Exploring Pacing Strategies and Pharmacological Interventions in Preventing Pacing-Induced Cardiomyopathy

Pacing-induced cardiomyopathy (PiCM) is a well-recognized but underappreciated complication in the field of cardiac electrophysiology, arising primarily from long-term right ventricular pacing (RVP). As pacemaker implantation becomes more common for managing bradyarrhythmias and conduction blocks, concern grows regarding the association between chronic RVP and adverse left ventricular remodeling. Recent years have seen promising developments in alternative pacing approaches—such as biventricular cardiac resynchronization therapy (BiV-CRT) and conduction system pacing (CSP)—which aim to mitigate dyssynchrony and preserve ventricular function. However, inconsistencies in how PiCM is defined in both clinical practice and research, and variability in identifying patient populations at greatest risk, complicate both diagnosis and the assessment of intervention efficacy. Ongoing debate surrounds the comparative benefits of emerging device-based strategies and adjunctive pharmacological interventions, such as the use of ACE inhibitors and β-blockers, yet high-quality evidence remains limited.This Research Topic aims to critically evaluate and synthesize current knowledge on pacing strategies and pharmacological interventions with the objective of preventing and managing PiCM. The aim is to address fundamental questions surrounding optimal patient selection, standardization of PiCM diagnostic criteria, and to determine which interventions provide the greatest benefit in real-world settings. Key goals include clarifying risk factors for PiCM, exploring mechanistic pathways, and generating evidence to inform best practices for therapy—both device- and drug-based. Submissions addressing comparative effectiveness, risk stratification, and novel therapeutic approaches are particularly encouraged to help shape consensus and guidelines for this challenging clinical issue.To gather further insights in this rapidly evolving field, we welcome articles that focus on pacing-induced cardiomyopathy across diverse patient groups and care settings. The scope includes, but is not limited to:Standardization and validation of PiCM definitions and diagnostic criteriaComparative studies of right ventricular pacing, biventricular CRT, and conduction system pacingMechanistic studies on myocardial remodeling and ventricular synchronyPharmacological interventions: role of ACE inhibitors, β-blockers, and emerging agentsRisk stratification models and personalized patient selection for alternative pacingLong-term outcomes, quality of life, and cost-effectiveness analysesPractical implementation, barriers, and guideline development for PiCM prevention and management Topic editors: Michael Spartalis, Sergio Conti Source: https://www.frontiersin.org/research-topics/85815/exploring-pacing-strategies-and-pharmacological-interventions-in-preventing-pacing-induced-cardiomyopathy