Deterioration of Cardiac Function Complicated by Ventricular Tachycardia After the Implantation of an Artificial Cardiac Pacemaker and Upgrading to CRT‐D: One Case Report

We reported an aging male patient who experienced deterioration of cardiac function accompanied by the onset of ventricular tachycardia 10 months after right ventricular pacing (RVP). We reviewed the literature on the mechanism of pacing‐induced cardiomyopathy (PICM) and the physiological pacing techniques commonly employed in current clinical practice. The patient is a 68‐year‐old male who experienced a decline in cardiac function accompanied by the onset of ventricular tachycardia 10 months after dual‐chamber pacemaker implantation for “atrioventricular block.” After excluding other potential causes of cardiac dysfunction, pacing‐induced cardiomyopathy (PICM) was diagnosed. Given the history of ventricular tachycardia episodes, the non‐physiological right ventricular pacing was upgraded to physiological biventricular synchronous pacing with defibrillator therapy (CRT‐D). During the one‐month follow‐up after CRT‐D implantation, the patient's symptoms of chest tightness and dyspnea were significantly alleviated. Repeated echocardiography revealed a marked improvement in left ventricular ejection fraction (LVEF), and the left ventricular end‐diastolic diameter (LVEDD) returned to the size observed before the initial pacemaker implantation. PICM was successfully corrected, and ventricular remodeling was reversed. Right ventricular pacing is associated with PICM in certain patients. Despite the availability of various surgical modalities for physiological pacing, pacing experts should select an individualized physiological pacing protocol that is specifically tailored to the specific condition of each patient.