Abstract
Right ventricular apical (RVA) pacing is known to cause left ventricular (LV) dysfunction, myocardial perfusion defects, abnormal septal contractility, asymmetrical septal hypertrophy, and heart failure in some patients.1–2 However, RV pacing-induced LV apical dyskinesis has not been previously described in the literature. We report a case of RVA pacing-induced LV apical dyskinesis that resolved acutely and was accompanied by a global improvement in LV systolic function after biventricular (BiV) pacing therapy with relocation of the RV lead. Intraoperative real-time 3D echocardiography was used for the optimal RV and LV pacing site selection. The case is a 73-year-old patient with complete heart block who underwent dual-chamber pacing (right atrial appendage and RVA pacing) for complete heart block, 3 years before the presentation. At baseline, she had normal ventricular function with an ejection fraction (EF) of 65%; however over the last 2 years, she had progressive LV dysfunction and worsening symptoms of congestive heart failure. A follow-up echocardiogram at this time showed an ejection fraction of 15% and marked dyskinesis of the LV apex. Based on a presumptive diagnosis of RVA …
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