A dual-chamber pacemaker was implanted because of symptomatic bradycardia in a 60-year-old patient free from other heart disease. Then, the patient developed acute congestive heart failure due to pacing-induced mitral regurgitation (MR). Under echocardiographic guidance, modification of location of the right ventricular pacing lead led to a significant decrease in MR severity resulting in immediate clinical improvement.
[Show abstract][Hide abstract] ABSTRACT: Right ventricular apical pacing may cause or worsen mitral regurgitation (MR). Potential mechanisms for this adverse sequelae include intraventricular dyssynchrony, altered papillary muscle function, pacing-induced cardiomyopathy with left ventricular dilation, and annular dilation. In contrast, biventricular (BiV) pacing may improve MR presumably by opposing the negative effects. Whether or not left ventricular lead location is important in treating mitral regurgitation in patients with pacemakers is unknown.
We report a case of severe MR and left ventricular (LV) systolic failure in a patient with right ventricular pacing. Multiple potential etiologies for the worsening valve function were noted, and a stepwise iterative optimizing scheme that included basal lateral LV pacing improved mitral valve function and ameliorated heart failure symptoms.
Indian pacing and electrophysiology journal 03/2014; 14(2):75-8.
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