Korean Circ J.  2016 May;46(3):421-424. 10.4070/kcj.2016.46.3.421.

Reversal of Pacing-Induced Cardiomyopathy by Normal QRS Axis Pacing

• Yang JH
• Kim JY
• Kim SH
• Oh YS

• KMID: 2344457
• DOI: http://doi.org/10.4070/kcj.2016.46.3.421

Abstract

Right ventricular apical pacing has been a commonly used method for placement of permanent pacemaker, but it is known to be associated with ventricular dyssynchrony and may lead to heart failure. Septal pacing could be an alternative method to improve this complication but the results have been conflicting; hence, other strategies are needed. This case is about a patient with pacing-induced cardiomyopathy who showed much improvement after repositioning the leads to a site different from that of normally paced QRS axis.

Keyword

Pacemaker; Heart failure; Cardiac pacing; Cardiomyopathy

MeSH Terms

Cardiomyopathies*
Heart Failure
Humans
Methods

Figure

• 

  Fig. 1 Radiographic changes of the patient before and after normal QRS axis pacing. (A) Initial chest X-ray at admission shows implanted pacemaker with marked cardiomegaly. (B) Chest X-ray of the patient immediate post lead repositioning with resultant right ventricular lead placed in septum. (C) Chest X-ray of the patient 1 year after normal QRS axis pacing showing significant improvement of cardiomegaly.

• 

  Fig. 2 Electrocardiogram (ECG) changes of the patient before and after normal QRS axis pacing. The QRS duration was 144, 138, and 96 ms at admission, immediate post lead repositioning, and 6 months later, respectively. (A) Initial ECG at admission showing abnormal QRS axis. (B) ECG of the patient immediately after post lead repositioning to achieve normally paced QRS axis. (C) ECG of the patient 6 months after the lead repositioning.

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