Severe left ventricular systolic dysfunction after permanent pacemaker implantation: Should we pause before upgrading...

Area of Science:

• Cardiology
• Nuclear Medicine
• Pathology

Background:

• Left ventricular (LV) systolic dysfunction and heart failure (HF) can occur post-permanent pacemaker implantation (PPI).
• Cardiac resynchronisation therapy (CRT) is a common treatment for HF post-PPI.
• Unexplained progressive LV dysfunction warrants further investigation into underlying causes.

Purpose of the Study:

• To report a case of progressive LV dysfunction and HF following PPI.
• To investigate the potential cause of HF using advanced imaging and biopsy.
• To evaluate the efficacy of steroid therapy in a patient with cardiac sarcoidosis.

Main Methods:

• Utilized cardiac 18FDG-PET-CT scan to assess myocardial metabolism.
• Performed lymph node biopsy to confirm diagnosis.
• Administered steroid therapy for treatment.

Main Results:

• Cardiac 18FDG-PET-CT revealed abnormal myocardial FDG uptake, suggesting cardiac sarcoidosis (CS).
• Biopsy confirmed non-caseating granuloma, indicative of sarcoidosis.
• Steroid therapy led to resolution of HF symptoms and significant improvement in LV function.

Conclusions:

• Cardiac sarcoidosis can be an underlying cause of heart failure after permanent pacemaker implantation.
• 18FDG-PET-CT is a valuable tool for diagnosing cardiac sarcoidosis.
• Steroid therapy can be effective in managing heart failure secondary to cardiac sarcoidosis.