Abstract
Epicardial Cardiac pacing may lead to severe Mitral Regurgitation by one of the following mechanisms: 1) Inappropriate Atrioventricular interval. 2) Myocardial ischemia due to fast heart rate may cause transient papillary muscle dysfunction. 3) Right Ventricular apical pacing may lead to Left Ventricular dyssynchrony in the presence of optimal Atrioventricular synchrony. Acute severe Mitral Regurgitation leading to acute severe hemodynamic deterioration is a reported complication of Permanent Pacemaker insertion. Our case demonstrated acute severe MR as a consequence of RV Pacing leading to acute hemodynamic deterioration, which was relieved on withdrawal of pacing. Left Ventricular dyssynchrony can be relieved by reducing the peacemaker rate or changing to biventricular pacing, this reduces the severity of Mitral Regurgitation and improves the hemodynamics due to simultaneous activation of left and right ventricles. This case illustrates the acute and potentially dramatic effects of intra-Left Ventricular dyssynchrony upon Mitral Valve function. Informed consent was obtained from the patient to report the case. Thus right ventricular pacing can cause left ventricular dyssynchrony leading to worsening of Mitral Regurgitation. It is important to pay attention to mode of pacing when evaluating Mitral Regurgitation in patients with Right Ventricular pacemaker and unstable hemodynamics after initiation of pacing.
Highlights
Functional mitral regurgitation (MR) is characterized by the absence of structural abnormalities of the mitral valve leaflets, chordae, and papillary muscles
Our case demonstrated acute severe MR as a consequence of right ventricular (RV) Pacing leading to acute hemodynamic deterioration, which was relieved on withdrawal of pacing
Left Ventricular dyssynchrony can be relieved by reducing the peacemaker rate or changing to biventricular pacing, this reduces the severity of Mitral Regurgitation and improves the hemodynamics due to simultaneous activation of left and right ventricles
Summary
Functional mitral regurgitation (MR) is characterized by the absence of structural abnormalities of the mitral valve leaflets, chordae, and papillary muscles. Left intraventricular conduction delay or its equivalent in the form of right ventricular (RV) pacing may precipitate or aggravate varying degrees of functional Mitral Regurgitation. Severe pacemaker-induced Mitral Regurgitation may be partially or largely reversible by restoration of LV synchrony with LV/biventricular pacing and in the occasional patient by programming the pacemaker to a low rate to permit the emergence of spontaneous beats thereby eliminating LV dyssynchrony [1]. The following case report demonstrates the RV pacing induced Mitral Regurgitation in the peri-operative period
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