Diastolic mitral regurgitation after dual chamber pacemaker

Area of Science:

• Cardiology
• Electrophysiology
• Medical Devices

Background:

• First-degree Atrioventricular (AV) block can precipitate heart failure symptoms attributed to AV dyssynchrony.
• Conduction system pacing (CSP) offers an alternative to traditional pacing methods.

Observation:

• A 40-year-old male with symptomatic 2:1 AV block and intermittent first-degree AV block received a dual-chamber pacemaker with CSP.
• Initial programming with managed ventricular pacing (MVP) and prolonged AV delays led to dyspnea and diastolic mitral regurgitation due to AV dyssynchrony.

Findings:

• AV delay optimization was performed, resolving the patient's symptoms.
• The patient became asymptomatic with successful atrial sensing and 100% ventricular pacing.

Implications:

• This case underscores the critical role of individualized AV delay optimization in CSP for achieving symptomatic improvement.
• Tailoring pacing parameters is essential for mitigating adverse effects like heart failure exacerbation in patients undergoing CSP.