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Rapidly progressive heart failure after dual-chamber pacemaker implantation
  1. Claire Seydoux1,
  2. Philipp Suter1,
  3. Denis Graf2 and
  4. Hari Vivekanantham2
  1. 1Department of Internal Medicine, HFR Fribourg Hopital cantonal, Fribourg, Switzerland
  2. 2Department of Cardiology, HFR Fribourg Hopital cantonal, Fribourg, Switzerland
  1. Correspondence to Dr Philipp Suter; philipp.suter{at}


Pacing-induced cardiomyopathy (PICM) consists of heart failure (HF) associated with a drop in the left ventricular ejection fraction (LVEF) in the setting of high-burden right ventricular pacing, with presentation that may range from subclinical to severe. Time to manifestation can go from weeks to years after device implantation. Treatment typically consists in an upgrade to a cardiac resynchronisation therapy (CRT) or His bundle pacing (HisP). Several risk factors for PICM have been described and should be considered before pacemaker (PM) implantation, as thorough patient selection for de novo CRT or HisP, may preclude its manifestation. We present the case of an 82-year-old patient presenting with acute congestive HF and new severely reduced LVEF, 30 days following dual chamber PM implantation for high-grade atrioventricular block. Treatment with HF medication and upgrade to a CRT permitted rapid resolution of the symptoms and normalisation of the LVEF at 1-month follow-up.

  • cardiovascular medicine
  • arrhythmias
  • heart failure
  • pacing and electrophysiology

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  • Contributors CS is the first author, performed the literature research, wrote the draft and was involved in the patient’s care. PS was involved in the patient’s care and revised the draft critically for important intellectual content. DG was involved in the patient’s care and revised the draft critically for important intellectual content. HV was involved in the patient’s care, acquired the echocardiographic images, made the device follow-up and reviewed the draft. DG and HV share last authorship.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.