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Evaluation of right ventricular pacing-induced coronary microvascular dysfunction using guide wire-based sensor

Takashi Mishina^1,2, Naoya Inoue^1,2, Shuji Morikawa^1,2

¹Department of Cardiology, Chutoen General Medical Center, 1-1 Shobugaike, Kakegawa, 436-8555 Shizuoka, Japan.

European Heart Journal. Case Reports

|February 7, 2025

Summary

Right ventricular pacing can worsen chest pain by impairing coronary microcirculation, even without blocked arteries. This finding is crucial for diagnosing non-obstructive coronary artery disease.

Keywords:

Case report Chest pain Coronary microvascular dysfunction Ischaemic non-obstructive coronary artery disease Right ventricular pacing

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Area of Science:

Cardiology
Medical Devices
Diagnostic Imaging

Background:

Ischaemic non-obstructive coronary artery disease diagnosis is vital for chest pain evaluation.
Pathophysiology of chest pain and coronary microcirculation in patients with right ventricular pacing (RVP) require further investigation.

Observation:

A patient with pre-existing chest pain experienced increased symptoms post-pacemaker implantation.
Coronary angiography showed no significant epicardial stenosis, but coronary microvascular dysfunction (CMD) was suspected.
Microcirculatory resistance increased during RVP compared to native rhythm.

Findings:

Right ventricular pacing (RVP) can induce or exacerbate coronary microvascular dysfunction (CMD).
Pacing-induced left ventricular dyssynchrony may contribute to CMD, particularly in the LAD territory.
RVP is a potential contributing factor to pacing-induced structural CMD and chest pain.

Implications:

Understanding RVP's impact on coronary microcirculation is essential for managing chest pain in pacemaker patients.
This study highlights the need for evaluating CMD in patients with unexplained chest pain and RVP.
Further research into RVP's role in CMD can improve patient outcomes and diagnostic strategies.