Key result
Biventricular pacing upgrade partially reverses right ventricular septal pacing-induced cardiomyopathy and severe LVEF drop.
Why the study?
Right ventricular septal pacing is thought to cause less left ventricular dysfunction than apical pacing, but its potential to induce acute left ventricular dysfunction remains unclear.
Can right ventricular septal pacing induce left ventricular dysfunction and heart failure in patients with complete atrioventricular block?
Case Report (n=1)
No
Can right ventricular septal pacing induce left ventricular dysfunction and heart failure in patients with complete atrioventricular block?
Right ventricular septal pacing can unpredictably induce reversible left ventricular dysfunction and heart failure secondary to dyssynchrony, which can be effectively managed by upgrading to biventricular pacing.
RV septal pacing may induce severe LVEF decline and HF; single case leaves open whether BiV upgrade warrants prospective evaluation.
INTRODUCTION: Right ventricular apical pacing-related heart failure is reported in some patients after long-term pacing. The exact mechanism is not yet clear but may be related to left ventricular dyssynchrony induced by right ventricular apical pacing. Right ventricular septal pacing is thought to deteriorate left ventricular function less frequently because of a more normal left ventricular activation pattern. CASE PRESENTATION: We report the case of a 55-year-old Tunisian woman with preserved ventricular function, implanted with a dual-chamber pacemaker for complete atrioventricular block. Right ventricular septal pacing induced a major ventricular dyssynchrony, severe left ventricular ejection fraction deterioration and symptoms of congestive heart failure. Upgrading to a biventricular device was associated with a decrease in the symptoms and the ventricular dyssynchrony, and an increase of left ventricular ejection fraction. CONCLUSION: Right ventricular septal pacing can induce reversible left ventricular dysfunction and heart failure secondary to left ventricular dyssynchrony. This complication remains an unpredictable complication of right ventricular septal pacing.
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Ouali et al. (2011) conducted a case report in Complete atrioventricular block (n=1). Right ventricular septal pacing was evaluated on Left ventricular ejection fraction and heart failure symptoms. Right ventricular septal pacing induced severe left ventricular ejection fraction deterioration (from 60% to 28%) and congestive heart failure, which partially reversed after upgrading to biventricular pacing.
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