Rapidly progressive heart failure after dual-chamber pacemaker implantation

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Claire Seydoux1, Philipp Suter2, Denis Graf3

  • 1Department of Internal Medicine, HFR Fribourg Hopital cantonal, Fribourg, Switzerland.

BMJ Case Reports
|October 14, 2021
PubMed

Insights

Pacing-induced cardiomyopathy (PICM) can cause heart failure after pacemaker implantation. Upgrading to cardiac resynchronization therapy (CRT) can rapidly resolve symptoms and improve heart function.

Area of Science:

  • Cardiology
  • Electrophysiology
  • Heart Failure Research

Background:

  • Pacing-induced cardiomyopathy (PICM) is heart failure (HF) linked to high-burden right ventricular pacing.
  • Symptoms can range from subclinical to severe, appearing weeks to years post-implantation.
  • Risk factors for PICM necessitate careful patient selection for pacemaker (PM) or cardiac resynchronization therapy (CRT) implantation.

Observation:

  • An 82-year-old patient developed acute congestive HF and reduced LVEF 30 days after dual-chamber PM implantation for high-grade AV block.
  • The patient presented with symptoms of acute heart failure and a significantly decreased left ventricular ejection fraction (LVEF).

Findings:

  • Treatment with HF medication and upgrade to CRT led to rapid symptom resolution.
  • LVEF normalized within one month following the CRT upgrade.

Implications:

  • This case highlights the potential for PICM following standard PM implantation.
  • Early recognition and intervention with CRT can effectively manage and reverse PICM.
  • Optimizing patient selection for initial pacing strategies may prevent PICM development.

Keywords:
arrhythmiascardiovascular medicineheart failurepacing and electrophysiology

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