Aim The aim of this study was to assess the incidence and clinical predictors of the development of new-onset heart failure (HF) over medium-term follow-up, in patients treated with permanent pacing in daily clinical practice. Methods and results We retrospectively enrolled all consecutive patients who underwent single-or dual-chamber pacemaker implantation at the study centre. Patients with a left ventricular ejection fraction (LVEF) ≤35% or a prior diagnosis of HF were excluded. Ventricular

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... ads were routinely implanted in the right apex. Pacemakers were implanted in 490 patients with a standard pacemaker indication and LVEF .35%. Left bundle-branch block (LBBB) was reported in 30 (8%) patients, and an LVEF ,50% in 64 (13%) patients. During a follow-up of 27 + 21 months, 32 (7%) patients reached the combined endpoint of HF death or hospitalization. On multivariate analysis, LBBB (HR, 3.50; 95% CI, 1.1 -11.1; P ¼ 0.033) and LVEF ,50% (HR, 5.1; 95% CI, 1.9-14.2; P ¼ 0.002) were confirmed as independent predictors of HF death or hospitalization. Patients with LVEF ,50% and/or LBBB displayed significantly higher rates of HF death or hospitalization (log-rank test, all P,0.001). Conclusion The majority of patients with a standard indication for permanent pacing and normal LV function remained in a clinically stable condition after pacemaker implantation. However, 7% of patients developed new-onset HF over a period of follow-up of 27 months, and the presence of LBBB and LVEF ,50% at the baseline predicted HF death or hospitalization. ---