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Rapidly progressive heart failure after dual-chamber pacemaker implantation
Claire Seydoux1, Philipp Suter2, Denis Graf3
1Department of Internal Medicine, HFR Fribourg Hopital cantonal, Fribourg, Switzerland.
BMJ Case Reports
|October 14, 2021
Summary
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.
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