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Pacing-induced left ventricular dysfunction. Relationship with coronary perfusion.

C C de Cock1, L M van Campen, O Kamp

  • 1Department of Cardiology, University Hospital VU, Amsterdam, The Netherlands.

Europace : European Pacing, Arrhythmias, and Cardiac Electrophysiology : Journal of the Working Groups on Cardiac Pacing, Arrhythmias, and Cardiac Cellular Electrophysiology of the European Society of Cardiology
|March 7, 2001
PubMed
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Pacemaker implantation for complete heart block led to acute heart failure. This suggests that cardiac stimulation from pacemakers can impair regional coronary flow and worsen left ventricular function.

Area of Science:

  • Cardiology
  • Cardiac Electrophysiology
  • Cardiovascular Imaging

Background:

  • Complete heart block necessitates pacemaker implantation for hemodynamic stability.
  • Pre-implantation assessment revealed normal left ventricular function via echocardiography.
  • DDD pacemaker implantation was performed for symptomatic complete heart block.

Observation:

  • Following pacemaker implantation, the patient developed acute congestive heart failure.
  • Echocardiography revealed extensive regional hypo- and akinetic segments in the anteroseptal, anterolateral, and apical left ventricular regions.
  • Methoxyisobuticeisonitrite (MIBI) perfusion imaging demonstrated hypoperfusion in the same affected left ventricular areas at rest.

Findings:

  • Coronary angiography showed normal epicardial coronary vessels, ruling out obstructive coronary artery disease.

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  • Impaired regional coronary flow was identified in specific left ventricular segments.
  • These findings correlated with the observed left ventricular dysfunction post-pacemaker implantation.

    • Implications:

    • Cardiac stimulation from pacemakers may be associated with impaired regional coronary blood flow.
    • This impairment can lead to significant deterioration of left ventricular function.
    • Further investigation is warranted to understand the mechanisms linking pacemaker stimulation to coronary microvascular dysfunction.