[Functional mitral incompetence after His ablation and implantation of pacemaker]

We describe the case of a 63 year-old patient with normal ejection fraction and trivial mitral regurgitation, who developed severe functional mitral incompetence (FMI) with pulmonary oedema the day after uncomplicated His ablation and implantation of VVI pacemaker. Mitral annuloplasty was performed with acceptable but not optimal outcome. Mechanical dyssynchrony with altered timing of the complete mitral valve apparatus is considered to be the main reason of the FMI. Upgrading of the pace system to biventricular pacing has been shown to be successful in severe pacemaker induced FMI.