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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.
Insights
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.
- 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.
Abstract:
In a patient admitted with symptomatic complete heart block, a DDD pacemaker was implanted. Prior to implantation, echocardiography showed normal left ventricular function. Shortly after implantation, acute congestive heart failure developed with extensive regional hypo- and akinetic segments in the anteroseptal, anterolateral and apical region. Subsequent perfusion imaging with methoxyisobuticeisonitrite (MIBI) at rest demonstrated hypoperfusion in the same regions while coronary angiography showed normal epicardial coronary vessels. Thus, impaired regional coronary flow can be associated with cardiac stimulation, inducing marked deterioration of left ventricular function.