INTERROGATING THE QUESTION: PACEMAKER-INDUCED CARDIOMYOPATHY SECONDARY TO TRANSCATHETER AORTIC VALVE REPLACEMENT-INDUCED HIGH-DEGREE HEART BLOCK

Document Type

Conference Proceeding

Publication Date

4-1-2024

Publication Title

J Am Coll Cardiol

Abstract

Background Pacemaker-induced cardiomyopathy (PICM) is defined as a drop in the left ventricular ejection fraction (LVEF) in the setting of long-standing high burden right ventricular pacing. The rise in use of implantable cardiac pacemakers has increased patient's quality of life, however complications such as infections, lead malfunction, and cardiomyopathy may arise. Case A 90-year-old white gentleman, with a past medical history of hypertension, coronary artery disease (CAD), sick sinus syndrome (SSS) requiring a dual-chamber permanent pacemaker implantation, severe aortic stenosis requiring a transcatheter aortic valve replacement (TAVR), presented for three weeks of exertional dyspnea, orthopnea, and bilateral leg swelling. He was hemodynamically stable, but hypoxic requiring oxygen supplementation. Initial workup revealed elevated BNP and elevated troponins. Electrocardiogram showed an AV-paced rhythm and no signs of ischemia. Chest radiograph showed bilateral pulmonary edema. Transthoracic echocardiogram showed a new decreased LVEF of 38% (previously 56%), no regional wall motion abnormalities, and a 26 mm Edwards Sapien 3 transcatheter aortic valve prosthesis with mild perivalvular regurgitation and TAPSE of 2.02 cm. Decision-making Device interrogation found an AV-paced rhythm with a right ventricular pacing of 99%. The last one, six months prior to this admission (four months before TAVR) showed a right ventricular pacing of 1%. Upon our discussion, patient was diagnosed with PICM. Electrophysiology was consulted, and upon stabilization of the patient's congestive heart failure, performed a device upgrade to a Cardiac Resynchronization Therapy (CRT), without any complications. Patient's condition improved significantly with this procedure and the use of intravenous loop diuretics. Ultimately, patient was discharged without oxygen supplementation requirements. Conclusion Conduction abnormalities are well-known complications of TAVR that often require pacemaker implantation. Patients with pacemakers require a careful device interrogation and right ventricular pacing assessment to diagnose PICM, for which CRT is a treatment of choice.

Volume

83

Issue

13

First Page

3176

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