Key result
Increasing pacing rate to 90 beats/min improves symptoms and reduces RV size in right-sided HF.
Why the study?
Treatment options remain limited for patients with right-sided heart failure and severe tricuspid regurgitation, and whether a higher heart rate is beneficial in these patients remains unclear.
Does increasing the permanent pacing rate from 60 to 90 beats/min improve hemodynamics and symptoms in a patient with right-sided heart failure and severe tricuspid regurgitation?
Case Report (n=1)
Does increasing the permanent pacing rate from 60 to 90 beats/min improve hemodynamics and symptoms in a patient with right-sided heart failure and severe tricuspid regurgitation?
Increasing the permanent pacing rate from 60 to 90 beats/min may optimize right-sided heart hemodynamics and relieve symptoms in selected patients with refractory right-sided heart failure and severe tricuspid regurgitation.
BACKGROUND: Treatment options remain limited for patients with right-sided heart failure (RHF) and severe tricuspid regurgitation (TR). Whether higher heart rate is beneficial in patients with RHF remains unclear. CASE SUMMARY: A 74-year-old woman with RHF and severe TR experienced marked hemodynamic and symptomatic improvement after increasing her permanent pacing rate from 60 to 90 beats/min. At 3 months, rate reduction to 60 beats/min provoked symptom recurrence within 3 days; restoring the rate to 90 beats/min promptly relieved symptoms. At 6 months, left ventricular ejection fraction remained preserved and right ventricular size remained reduced, although TR remained severe. DISCUSSION: This case suggests that increasing the pacing rate may optimize right-sided heart hemodynamics and improve symptoms in selected patients with RHF, although further validation is needed. TAKE-HOME MESSAGE: An on-off-on response to pacing-rate adjustment-symptoms improving with higher rates and worsening at lower rates-supports a potential beneficial effect of heart rate elevation in selected patients with refractory RHF.
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Mai et al. (2026) conducted a case report in Right-sided heart failure and severe tricuspid regurgitation (n=1). Permanent pacing rate acceleration vs. 60 beats/min was evaluated on Hemodynamic and symptomatic improvement, left ventricular ejection fraction, and right ventricular size. Increasing the permanent pacing rate from 60 to 90 beats/min improved symptoms and reduced right ventricular size at 6 months in a patient with right-sided heart failure.
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