{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,11]],"date-time":"2026-07-11T19:31:56Z","timestamp":1783798316242,"version":"3.55.0"},"reference-count":30,"publisher":"MDPI AG","issue":"21","license":[{"start":{"date-parts":[[2025,10,31]],"date-time":"2025-10-31T00:00:00Z","timestamp":1761868800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100003710","name":"the Korea Health Technology R&D Project","doi-asserted-by":"publisher","award":["RS-2023-00265440"],"award-info":[{"award-number":["RS-2023-00265440"]}],"id":[{"id":"10.13039\/501100003710","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: Pacemaker-associated heart failure (PaHF) is a recognized complication of chronic ventricular pacing, yet its long-term incidence and prognostic impact remain incompletely defined. Previous studies on PaHF have been largely limited by small sample sizes, single-center designs, and insufficient long-term or time-dependent analyses. We aimed to evaluate the incidence, clinical predictors, and mortality risk of PaHF in a nationwide real-world cohort. Methods: Using the Korean National Health Insurance Service database, we identified 32,216 patients who underwent de novo pacemaker implantation between 2008 and 2019 without prior heart failure. Results: During a median follow-up of 3.8 years, 4170 patients (12.9%) developed new-onset PaHF and 6184 (19.2%) died. PaHF was independently associated with increased all-cause mortality (adjusted hazard ratio [HR]: 3.11, 95% confidence interval [CI]: 2.93\u20133.32, p &lt; 0.001), even after accounting for immortal-time bias and relevant covariates. The incidence of PaHF and its associated mortality risk both peaked within the first six months post implantation and remained persistently elevated throughout follow-up; notably, PaHF-associated mortality showed a late resurgence. Sensitivity and subgroup analyses consistently demonstrated higher mortality among patients with PaHF across a wide range of clinical characteristics. Conclusions: In this large, nationwide cohort, the development of PaHF was associated with a substantial and sustained increase in mortality risk following pacemaker implantation. Given the persistent and dynamic nature of this risk, longitudinal monitoring of cardiac function and individualized pacing strategies may be warranted to mitigate long-term adverse outcomes. Additionally, these findings provide real-world benchmarks to guide future pacing strategies and surveillance efforts.<\/jats:p>","DOI":"10.3390\/jcm14217744","type":"journal-article","created":{"date-parts":[[2025,11,3]],"date-time":"2025-11-03T18:21:46Z","timestamp":1762194106000},"page":"7744","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Temporal Trends and Prognostic Impact of Pacemaker-Associated Heart Failure: Insights from a Nationwide Cohort Study"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1461-5597","authenticated-orcid":false,"given":"Young Jun","family":"Park","sequence":"first","affiliation":[{"name":"Division of Cardiology, Department of Internal Medicine, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju 26426, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3564-4220","authenticated-orcid":false,"given":"Sungjoo","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Digital Health, Samsung Advanced Institute for Health Sciences & Technology, Sungkyunkwan University, Seoul 03036, Republic of Korea"},{"name":"Biomedical Statistics Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul 06351, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2797-238X","authenticated-orcid":false,"given":"Sungjun","family":"Hong","sequence":"additional","affiliation":[{"name":"Department of Digital Health, Samsung Advanced Institute for Health Sciences & Technology, Sungkyunkwan University, Seoul 03036, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kyunga","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Digital Health, Samsung Advanced Institute for Health Sciences & Technology, Sungkyunkwan University, Seoul 03036, Republic of Korea"},{"name":"Biomedical Statistics Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul 06351, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juwon","family":"Kim","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Internal Medicine, Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-2452-4423","authenticated-orcid":false,"given":"Ju Youn","family":"Kim","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Internal Medicine, Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kyoung-Min","family":"Park","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Internal Medicine, Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Young Keun","family":"On","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Internal Medicine, Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3288-0594","authenticated-orcid":false,"given":"Seung-Jung","family":"Park","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Internal Medicine, Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,10,31]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"643","DOI":"10.1002\/ejhf.1427","article-title":"Clinical features, predictors, and long-term prognosis of pacing-induced cardiomyopathy","volume":"21","author":"Cho","year":"2019","journal-title":"Eur. 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