Right ventricular pacing is associated with the development of pacing-induced cardiomyopathy in a subset of patients, highlighting the need for tools that identify individuals at higher risk before pacing strategy selection. In Pacing and Clinical Electrophysiology, a retrospective multicenter study developed and validated a clinical prediction model to estimate the risk of pacing-induced cardiomyopathy (PICM) in patients undergoing permanent right ventricular pacing.

The study evaluated consecutive patients who received permanent right ventricular pacing at two centers between January 2013 and December 2022. One cohort served as the derivation set and the other as the validation set. Clinical, echocardiographic, and electrocardiographic variables were collected at baseline and during follow-up. Two prediction models were constructed using different variable selection methods, and the final model was selected based on simplicity and performance. A nomogram was developed from the selected model and externally validated.

The derivation cohort included 374 patients, of whom 74 (19.8%) developed PICM. The final Cox proportional hazards model incorporated ejection fraction (EF), left ventricular end-systolic diameter (LVESD), baseline QRS duration, and atrial fibrillation (AF) status. The nomogram demonstrated moderate discrimination, with a C statistic of 0.75 (95% confidence interval, 0.70–0.81), and showed accurate calibration. Performance remained consistent during internal validation and was maintained in the external validation cohort. The model effectively distinguished between high-risk and low-risk populations.

The tool provides individualized estimates of 3-, 5-, and 8-year PICM risk in patients receiving right ventricular pacing and may inform pacing strategy selection.