A case of systemic sclerosis with worsened subclinical left ventricular systolic dysfunction after pacemaker...

Area of Science:

• Cardiology
• Rheumatology
• Medical Devices

Background:

• Systemic sclerosis (SSc) is an autoimmune disease that can affect multiple organs, including the heart.
• Cardiac involvement in SSc can manifest as heart failure, arrhythmias, and conduction abnormalities.
• Pacemaker implantation is sometimes necessary for SSc patients with conduction issues.

Observation:

• A 58-year-old man with SSc developed heart failure after pacemaker implantation for atrioventricular block.
• Pre-existing subclinical left ventricular systolic dysfunction was identified via global longitudinal strain, despite a normal ejection fraction.
• Right ventricular pacing was suspected to exacerbate left ventricular dysfunction.

Findings:

• Upgrading to cardiac resynchronization therapy improved left ventricular ejection fraction but not global longitudinal strain.
• This suggests SSc patients may have baseline subclinical myocardial impairment.
• Right ventricular pacing can potentially worsen pre-existing left ventricular systolic dysfunction.

Implications:

• Consider subclinical left ventricular dysfunction in SSc patients requiring pacemakers.
• Speckle-tracking echocardiography can aid in assessing cardiac function in SSc.
• Careful pacemaker lead placement and pacing mode selection are crucial for SSc patients to prevent further cardiac deterioration.