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An approach to the stepwise management of severe mitral regurgitation with optimal cardiac pacemaker function

Christopher V Desimone1, Vuyisile T Nkomo1, Daniel C Desimone2

  • 1Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, MN.

Indian Pacing and Electrophysiology Journal
|March 27, 2014
PubMed

Insights

Right ventricular pacing can worsen mitral regurgitation. Optimizing left ventricular lead placement, specifically basal lateral pacing, improved mitral valve function and heart failure symptoms in a patient with severe mitral regurgitation.

Area of Science:

  • Cardiology
  • Cardiac Electrophysiology
  • Cardiovascular Imaging

Background:

  • Right ventricular apical pacing is associated with mitral regurgitation (MR).
  • Mechanisms include dyssynchrony, papillary muscle dysfunction, and ventricular dilation.
  • Biventricular (BiV) pacing may mitigate MR, but the role of left ventricular (LV) lead location is unclear.

Purpose of the Study:

  • To investigate the impact of LV lead position on MR in a patient with pacing-induced heart failure.
  • To describe a case of severe MR and LV systolic failure managed with optimized pacing.

Main Methods:

  • Case report of a patient with severe MR and LV systolic failure.
  • Iterative optimization of pacing parameters and LV lead location.
  • Assessment of mitral valve function and heart failure symptoms.

Main Results:

  • Right ventricular apical pacing was associated with severe MR and LV systolic failure.
  • Optimizing LV lead placement to the basal lateral region improved mitral valve function.
  • Heart failure symptoms were ameliorated with the adjusted pacing strategy.

Conclusions:

  • Left ventricular lead location is a critical factor in managing MR in pacemaker patients.
  • Basal lateral LV pacing may be an effective strategy to improve MR and heart failure.
  • This case highlights the importance of lead optimization in pacing-related cardiac dysfunction.
Keywords:
cardiac pacemakermitral regurgitation

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