Right ventricular pacing can induce severe functional mitral regurgitation and hemodynamic instability due to left ventricular dyssynchrony, which is reversible upon cessation of pacing or restoration of synchrony.
RV pacing may induce reversible severe MR and instability; case report leaves open questions on prevalence and mechanisms.
Epicardial Cardiac pacing may lead to severe Mitral Regurgitation by one of the following mechanisms: 1) Inappropriate Atrioventricular interval. 2) Myocardial ischemia due to fast heart rate may cause transient papillary muscle dysfunction. 3) Right Ventricular apical pacing may lead to Left Ventricular dyssynchrony in the presence of optimal Atrioventricular synchrony. Acute severe Mitral Regurgitation leading to acute severe hemodynamic deterioration is a reported complication of Permanent Pacemaker insertion. Our case demonstrated acute severe MR as a consequence of RV Pacing leading to acute hemodynamic deterioration, which was relieved on withdrawal of pacing. Left Ventricular dyssynchrony can be relieved by reducing the peacemaker rate or changing to biventricular pacing, this reduces the severity of Mitral Regurgitation and improves the hemodynamics due to simultaneous activation of left and right ventricles. This case illustrates the acute and potentially dramatic effects of intra-Left Ventricular dyssynchrony upon Mitral Valve function. Informed consent was obtained from the patient to report the case. Thus right ventricular pacing can cause left ventricular dyssynchrony leading to worsening of Mitral Regurgitation. It is important to pay attention to mode of pacing when evaluating Mitral Regurgitation in patients with Right Ventricular pacemaker and unstable hemodynamics after initiation of pacing.
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Motwani et al. (2018) studied this question.
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