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Pacing-induced Cardiomyopathy — EECC MCQ

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ModerateGeneral CardiologyPacing-induced CardiomyopathyEECC

A 60-year-old man with a dual-chamber pacemaker presents with breathlessness and fatigue. His pacemaker interrogation shows 95% ventricular pacing. Echocardiography shows a new reduction in LVEF from 55% to 38% since pacemaker implantation. What is the most likely diagnosis?

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Correct answer: D — Pacing-induced cardiomyopathy — chronic RV pacing causing LV dyssynchrony and progressive LV dysfunction

Pacing-induced cardiomyopathy (PICM) is a recognised complication of chronic right ventricular pacing, occurring in approximately 10-20% of patients with high ventricular pacing burden (>40%). RV apical pacing creates a non-physiological activation sequence (similar to LBBB), causing LV dyssynchrony and progressive remodelling. Risk factors include: high pacing percentage (>40%), pre-existing LV dysfunction, wide paced QRS. The 2021 ESC Pacing Guidelines recommend strategies to minimise unnecessary ventricular pacing (managed ventricular pacing algorithms) and consideration of CRT or conduction system pacing for patients who develop PICM. Upgrade from RV pacing to CRT typically results in LV function improvement.

Reference: ESC (2021): Guidelines on Cardiac Pacing and CRT