SHM Converge Scientific Abstract ePoster Gallery-Right Ventricular Dyssynchrony Leading to Left Ventricular Failure

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This document describes a case of pacemaker-induced cardiomyopathy (PICM) in a 76-year-old man who presented with weakness, shortness of breath, and volume overload after recent pacemaker placement. He had atrial fibrillation, HFpEF, diabetes, leukemia, and colon cancer. Testing showed severe heart failure with BNP 40,856 pg/ml, a paced ECG with very wide QRS duration, and a new drop in LVEF from 55% to 30–35% over two weeks. Stress testing did not show ischemia, and pacemaker interrogation revealed 98% right ventricular pacing. Electrophysiology concluded that the high RV pacing burden and QRS duration suggested ventricular dyssynchrony causing PICM, and recommended upgrading to biventricular pacing.<br /><br />The document explains that PICM is caused by non-physiologic right ventricular activation, which delays left ventricular depolarization, leads to dyssynchrony, and over time causes structural remodeling and reduced LV function. Risk factors include male sex, prolonged paced QRS, baseline LV dysfunction, high pacing burden, and myocardial scar. PICM is variably defined, but often includes a drop in LVEF of at least 10% to below 50%, or a smaller decline with heart failure symptoms.<br /><br />It also notes that PICM is an underrecognized complication of pacemakers, affecting roughly 6–22% of patients, or about 10–20% over 3–4 years in some studies. Biventricular pacing is the main treatment and can improve ejection fraction. The conclusion emphasizes that PICM should be considered in patients who develop acute heart failure after pacemaker implantation, and that better tools are needed to assess ventricular dyssynchrony and guide treatment.

Asset Subtitle

Jenna Campbell

Meta Tag

Author List Ayesha Moghul, Jenna Campbell

Category Clinical Vignettes

Concept Pacemaker-Induced Cardiomyopathy

Concept Left Ventricular Ejection Fraction

Concept Heart Failure

Concept Right Ventricular Pacing

Concept Left Ventricular Dysfunction

Distinguished Non-Finalist

Presenter Organization Christiana Care

Presenting Author Jenna Campbell

Track Adult

Keywords

pacemaker-induced cardiomyopathy

PICM

right ventricular pacing

ventricular dyssynchrony

biventricular pacing

heart failure

paced QRS duration

left ventricular dysfunction

ejection fraction decline

pacemaker implantation

Pacemaker-Induced Cardiomyopathy

Left Ventricular Ejection Fraction

Heart Failure

Right Ventricular Pacing

Left Ventricular Dysfunction