Acute left ventricular dysfunction secondary to right ventricular septal pacing in a woman with initial preserved contractility: a case report

Abstract

IntroductionRight ventricular apical pacing-related heart failure is reported in some patients after long-term pacing. The exact mechanism is not yet clear but may be related to left ventricular dyssynchrony induced by right ventricular apical pacing. Right ventricular septal pacing is thought to deteriorate left ventricular function less frequently because of a more normal left ventricular activation pattern.Case presentationWe report the case of a 55-year-old Tunisian woman with preserved ventricular function, implanted with a dual-chamber pacemaker for complete atrioventricular block. Right ventricular septal pacing induced a major ventricular dyssynchrony, severe left ventricular ejection fraction deterioration and symptoms of congestive heart failure. Upgrading to a biventricular device was associated with a decrease in the symptoms and the ventricular dyssynchrony, and an increase of left ventricular ejection fraction.ConclusionRight ventricular septal pacing can induce reversible left ventricular dysfunction and heart failure secondary to left ventricular dyssynchrony. This complication remains an unpredictable complication of right ventricular septal pacing.

Apparent Acute Reversible Right Ventricular Pacing‐Induced Left Ventricular Dysfunction

“…Right ventricular apical pacing is associated with LV dyssynchrony and dysfunction 1,2 . There have been reports in the literature of progressive reversible LV dysfunction, but none that have reported instantaneous reversal or lack of LV remodeling 3–5 . This case shows the phenomenon of apparent acute LV dysfunction after initiation of RV pacing.…”

Cardiac Resynchronization Therapy as Rescue Therapy in End‐Stage Heart Failure: Illustration by Three‐Dimensional Speckle Tracking Strain Echocardiography

“…Accordingly, the detrimental effect of RV pacing on symptoms and LV function has been previously documented in patients with heart failure and preserved LVEF at baseline, with improvement of LV function following CRT. [4][5][6] This case suggests that CRT might be a valuable option in patients with refractory heart failure due to RV pacing. New imaging technologies such as 3D echocardiography with speckle tracking area strain may help to identify and follow up patients who will benefit from CRT rescue therapy.…”

“…The deterioration of LV systolic function after implantation of the dual‐chamber pacemaker was likely related to RV pacing, inducing LV dyssynchrony. Accordingly, the detrimental effect of RV pacing on symptoms and LV function has been previously documented in patients with heart failure and preserved LVEF at baseline, with improvement of LV function following CRT …”

Reversal of Pacing-Induced Cardiomyopathy by Normal QRS Axis Pacing

“… 6) 8) There is currently no exact data of reversibility of pacing-induced cardiomyopathy and the best treatment options to overcome these adverse effects, except some case reports. 9) 10) 11) 12) New strategies have been proposed, and clinical trials are ongoing.…”