Congenital complete atrioventricular block and dilated cardiomyopathy: new light for an old disease

Area of Science:

• Cardiology
• Electrophysiology
• Heart Failure

Background:

• Complete congenital atrioventricular block (CAVB) can necessitate long-term pacing.
• Pacemaker implantation, particularly VVI-R pacing, can be associated with the development of cardiomyopathy.
• Biventricular dysfunction presents a significant clinical challenge, often refractory to medical management.

Purpose of the Study:

• To report a case of VVI-R pacemaker-induced cardiomyopathy in a patient with CAVB.
• To evaluate the efficacy of cardiac resynchronization therapy (CRT) in managing severe biventricular dysfunction secondary to pacing in CAVB.
• To highlight the potential benefits of CRT in improving clinical and electrocardiographic parameters in such complex cases.

Main Methods:

• Case presentation of a patient with CAVB and subsequent dilated cardiomyopathy.
• Review of medical history including VVI-R pacemaker implantation and medical therapy.
• Application of cardiac resynchronization therapy (CRT) and assessment of outcomes.

Main Results:

• The patient developed severe biventricular dysfunction ten years post-pacemaker implantation.
• Optimal medical therapy was insufficient to alleviate symptoms.
• Following CRT, significant clinical and electrocardiographic improvement was observed within one month.

Conclusions:

• Cardiac resynchronization therapy can be a valuable treatment option for pacing-induced cardiomyopathy in patients with congenital heart block.
• CRT may reverse or improve severe biventricular dysfunction in selected cases.
• This case underscores the importance of considering advanced pacing strategies in patients with complex congenital cardiac conditions.