Key result
Upgrading to dual-chamber LBBAP narrows QRS and improves LV function and mitral regurgitation.
Why the study?
Dual-chamber leadless pacing relies on beat-to-beat implant-to-implant communication, and heart failure-related geometric changes may expose limited communication reserve.
Case Report (n=1)
Heart failure-related geometric changes can impair implant-to-implant communication in dual-chamber leadless pacemakers, and upgrading to transvenous left bundle branch area pacing can rescue both atrioventricular and ventricular dyssynchrony in pacing-induced cardiomyopathy.
Answers are grounded in this paper and cite their sources.
May support LBBAP upgrade for pacing-induced cardiomyopathy after leadless pacemaker failure; hypothesis-generating and requires prospective validation.
BACKGROUND: Dual-chamber leadless pacing depends on beat-to-beat implant-to-implant communication; heart failure-related geometric changes may expose limited communication reserve. CASE SUMMARY: A 92-year-old woman with complete atrioventricular block developed heart failure 9 months after dual-chamber leadless pacemaker implantation, with reduced atrial-to-ventricular (A-to-V) throughput, atrioventricular dissociation, ventricular functional and diastolic mitral regurgitation, and reduced left ventricular ejection fraction. Decongestion was accompanied by shortening of the projected interdevice distance, improvement in A-to-V throughput and atrioventricular synchrony, and disappearance of diastolic mitral regurgitation. Heart failure recurred despite preserved throughput and continued medical therapy. Upgrade to a transvenous dual-chamber pacemaker with left bundle branch area pacing narrowed the QRS and improved left ventricular function and mitral regurgitation. DISCUSSION: Pacing-induced cardiomyopathy appeared to be the dominant substrate, with dynamic A-to-V limitation as a reversible aggravating factor. Left bundle branch area pacing addressed both atrioventricular and ventricular dyssynchrony.
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Nakamura et al. (2026) conducted a case report in Complete atrioventricular block, pacing-induced cardiomyopathy, and heart failure (n=1). Upgrade to transvenous dual-chamber pacemaker with left bundle branch area pacing was evaluated on QRS duration, left ventricular function, and mitral regurgitation. Upgrading to a transvenous dual-chamber pacemaker with left bundle branch area pacing in 1 patient (age 92) narrowed the QRS and improved LV function and mitral regurgitation.
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