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Updated: Mar 22, 2026
08:31
A Simplified Stepwise Approach to Echo Guidance during Percutaneous Mitral Valve Repair
Published on: October 16, 2021
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Right Ventricular Pacing-Induced Heart Failure after Mitral Valve Replacement
Meng-Ta Tsai1, Wei-Chuan Tsai2, Jun-Neng Roan1
1Division of Cardiovascular Surgery, Department of Surgery;
Acta Cardiologica Sinica
|April 29, 2016
Summary
Increasing right ventricular pacing after mitral valve replacement can worsen heart failure. Reducing the pacing rate improved a patient’s condition, highlighting the need for careful pacing strategies in cardiac surgery patients.
Area of Science:
- Cardiology
- Cardiac Surgery
- Electrophysiology
Background:
- Mitral valve replacement is a common cardiac surgery.
- Right ventricular pacing is used for bradycardia or heart block.
- Pacing-induced heart failure is a potential complication.
Observation:
- A patient with chronic atrial fibrillation and a pacemaker underwent mitral valve replacement.
- Postoperative pacing rate was increased to aid weaning from cardiopulmonary bypass.
- The patient developed low cardiac output, persisting despite inotropes.
Findings:
- Echocardiography revealed ventricular dyssynchrony 29 days post-surgery.
- Reducing the right ventricular pacing rate below the patient's spontaneous rate improved dyssynchrony.
- This suggests a link between increased pacing and cardiac dysfunction.
Implications:
- Clinicians must be cautious when increasing right ventricular pacing in stunned myocardium post-cardiac surgery.
- Postoperative pacing strategies require careful consideration in patients with low cardiac output after mitral valve replacement.
- Further discussion on optimizing pacing in this patient population is warranted.
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