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Pacing-Induced Cardiomyopathy in Bradycardia-Induced Polymorphic Ventricular Tachycardia
Obiora Egbuche MD, MPH; Ifunanya Ekechukwu MD; Nnamdi Maduabum MPH; Tulani WashingtonPlaskett MD; Koreen Hall NP; Kelechi Ukpaka MPH; Rajesh Sachdeva MD
Background: Pacing-induced cardiomyopathy (PiCM) is frequently associated with right ventricular
(RV) pacing. This may occur in patients who require pacing more than 40-50% of the time. We present a
case of PiCM in a patient with bradycardia-induced polymorphic ventricular tachycardia (BiPVT).
Case Report: A 48-year-old African-American lady with a medical history of hypertension, presented
with cardiac arrest because of BiPVT. She had multiple episodes that were because of bradycardia
secondary to mobitz-type 2 atrioventricular block. Coronary angiography showed normal coronary
arteries, echocardiogram showed normal left ventricular systolic function with an ejection fraction (EF) of
60%. She underwent successful automatic implantable cardioverter-defibrillator (AICD) placement. Five
months later she presented with new-onset heart failure with BNP of 2369 pg/ml. A repeat
echocardiogram showed severe left ventricular systolic dysfunction with EF <25%. Her device
interrogation revealed no episodes of ventricular tachycardia and she was paced 90% of the time. She was
upgraded to cardiac resynchronization therapy-D (CRT-D) with improvement in EF to 55% and
resolution of symptoms after 3 months.
Discussion: PiCM is a known complication of chronic RV pacing in patients with high pacer demand.
Patients with BiPVT require higher rate pacing to prevent bradycardia that may predispose to ventricular
tachycardia. Our patient had AICD with high rate RV pacing set at 60 beats per minute. She developed
PiCM due to RV pacing and high pacing burden. Though all patients with BiPVT may not meet criteria
for CRT, selected patients who have high pacing burden should be considered for CRT as opposed to RV
pacing at the time of initial device implantation.
Conclusion: CRT may be preferred to RV pacing in patients with BiPVT who are suspected to have high
pacing burden.