Acute severe mitral regurgitation as an early complication of pacemaker implantation

Miranda, Rita; Almeida, Sofia; Brandão, Luis Felipe; Alvarenga, Carlos José Souza de; Ribeiro, Luciano Paes Landim; Almeida, Ana Rita; Carrageta, Manuel

doi:10.1093/europace/euq191

Cited by 11 publications

(8 citation statements)

References 2 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Post-MitraClip hemodynamics confirmed dramatic improvement in left atrial pressures throughout both paced and native rhythms ( Figure 5, Table 1). Transthoracic echocardiography on postoperative day 1 showed a mild decrease in left ventricular size and modest drop in left ventricular ejection fraction from 60-65% to 45-50% but with sustained mild residual MR. clinical scenarios ranging from acute severe MR immediately following pacemaker implantation to slow progression of MR in the setting of chronic right ventricular apical pacing [4][5][6].…”

Section: Discussionmentioning

confidence: 99%

Worsening of Functional Mitral Regurgitation from Septal Dyssynchrony Induced by Ventricular Pacing in Ebstein's Anomaly Undergoing Percutaneous Mitral Valve Repair

Bratincsák¹,

Rhee²,

Nguyen³

et al. 2017

jshd

View full text Add to dashboard Cite

A 67-year-old male with Ebstein's anomaly and a dual-chamber pacemaker due to sick sinus syndrome was admitted to our hospital with cardiogenic shock. Echocardiography revealed severe functional mitral valve regurgitation with preserved ejection fraction. He was referred for percutaneous mitral valve repair (PMVR) for refractory shock in the setting of prohibitive surgical risk. Invasive hemodynamics obtained during PMVR revealed worsening mitral regurgitation due to septal dyssynchrony induced by the patient's permanent pacing. He underwent successful PMVR with subsequent clinical recovery. Dyssynchrony from right ventricular apical pacing may exacerbate mitral regurgitation and heart failure. PMVR with MitraClip may be a safe and effective therapeutic option in patients with refractory cariogenic shock and severe mitral regurgitation.

show abstract

Section: Discussionmentioning

confidence: 99%

Worsening of Functional Mitral Regurgitation from Septal Dyssynchrony Induced by Ventricular Pacing in Ebstein's Anomaly Undergoing Percutaneous Mitral Valve Repair

Bratincsák¹,

Rhee²,

Nguyen³

et al. 2017

jshd

View full text Add to dashboard Cite

show abstract

“…The improvements in valvular regurgitation have come about through altering the site of right ventricular lead pacing to the interventricular septum [6], or placement in the right ventricular outflow tract [2]. Changing mode of pacing from VVI to atrial pacing with intrinsic ventricular rhythm has also been reported to improve MR [7].…”

Section: Discussionmentioning

confidence: 99%

“…Mitral regurgitation (MR) can worsen as a result of acute or chronic right ventricular apical pacing [1,2]. The mechanism is thought to be a consequence of intraventricular dyssynchrony and altered papillary muscle mechanics [3].…”

Section: Introductionmentioning

confidence: 99%

An Approach to the Stepwise Management of Severe Mitral Regurgitation with Optimal Cardiac Pacemaker Function

DeSimone

Nkomo

DeSimone

et al. 2014

Indian Pacing and Electrophysiology Journal

View full text Add to dashboard Cite

Right ventricular apical pacing may cause or worsen mitral regurgitation (MR). Potential mechanisms for this adverse sequelae include intraventricular dyssynchrony, altered papillary muscle function, pacing-induced cardiomyopathy with left ventricular dilation, and annular dilation. In contrast, biventricular (BiV) pacing may improve MR presumably by opposing the negative effects. Whether or not left ventricular lead location is important in treating mitral regurgitation in patients with pacemakers is unknown.We report a case of severe MR and left ventricular (LV) systolic failure in a patient with right ventricular pacing. Multiple potential etiologies for the worsening valve function were noted, and a stepwise iterative optimizing scheme that included basal lateral LV pacing improved mitral valve function and ameliorated heart failure symptoms.

show abstract

“…In 2010 Rita Miranda et al [14] continued problem of left atrium dysfunction. The authors first described acute mitral regurgitation complicated by pulmonary edema caused by RVA stimulation in short time observation.…”

Section: Left Atrium and Mitral Valve Dysfunction -Atrial Fibrillationmentioning

confidence: 99%

Alternative Right Ventricular Pacing Sites

Łuciuk¹,

Łuciuk²,

Gajek³

2015

Adv Clin Exp Med

View full text Add to dashboard Cite

Background. The main adverse effect of chronic stimulation is stimulation-induced heart failure in case of ventricular contraction dyssynchrony. Because of this fact, new techniques of stimulation should be considered to optimize electrotherapy. One of these methods is pacing from alternative right ventricular sites. Objectives. The purpose of this article is to review currently accumulated data about alternative sites of cardiac pacing. Material and Methods. Medline and PubMed bases were used to search English and Polish reports published recently.Results. Recent studies report a deleterious effect of long term apical pacing. It is suggested that permanent apical stimulation, by omitting physiological conduction pattern with His-Purkinie network, may lead to electrical and mechanical dyssynchrony of heart muscle contraction. In the long term this pathological situation can lead to severe heart failure and death. Because of this, scientists began to search for some alternative sites of cardiac pacing to reduce the deleterious effect of stimulation. Based on current accumulated data, it is suggested that the right ventricular outflow tract, right ventricular septum, direct His-bundle or biventricular pacing are better alternatives due to more physiological electrical impulse propagation within the heart and the reduction of the dyssynchrony effect. These methods should preserve a better left ventricular function and prevent the development of heart failure in permanent paced patients. As there is still not enough, long-term, randomized, prospective, cross-over and multicenter studies, further research is required to validate the benefits of using this kind of therapy. Conclusions. The article should pay attention to new sites of cardiac stimulation as a better and safer method of treatment (Adv Clin Exp Med 2015, 24, 2, 349-359).

show abstract

Acute severe mitral regurgitation as an early complication of pacemaker implantation

Cited by 11 publications

References 2 publications

Worsening of Functional Mitral Regurgitation from Septal Dyssynchrony Induced by Ventricular Pacing in Ebstein's Anomaly Undergoing Percutaneous Mitral Valve Repair

Worsening of Functional Mitral Regurgitation from Septal Dyssynchrony Induced by Ventricular Pacing in Ebstein's Anomaly Undergoing Percutaneous Mitral Valve Repair

An Approach to the Stepwise Management of Severe Mitral Regurgitation with Optimal Cardiac Pacemaker Function

Alternative Right Ventricular Pacing Sites

Contact Info

Product

Resources

About