Ouali Sana, Azzez Soufiene, Kacem Slim, Lagren Afef, Neffeti Elyes, Gribaa Rim, Remedi Fahmi, Boughzela Essia
Department of Cardiology, Sahloul Hospital, Sousse, Tunisia.
J Med Case Rep. 2011 Oct 25;5:524. doi: 10.1186/1752-1947-5-524.
Right ventricular apical pacing-related heart failure is reported in some patients after long-term pacing. The exact mechanism is not yet clear but may be related to left ventricular dyssynchrony induced by right ventricular apical pacing. Right ventricular septal pacing is thought to deteriorate left ventricular function less frequently because of a more normal left ventricular activation pattern.
We report the case of a 55-year-old Tunisian woman with preserved ventricular function, implanted with a dual-chamber pacemaker for complete atrioventricular block. Right ventricular septal pacing induced a major ventricular dyssynchrony, severe left ventricular ejection fraction deterioration and symptoms of congestive heart failure. Upgrading to a biventricular device was associated with a decrease in the symptoms and the ventricular dyssynchrony, and an increase of left ventricular ejection fraction.
Right ventricular septal pacing can induce reversible left ventricular dysfunction and heart failure secondary to left ventricular dyssynchrony. This complication remains an unpredictable complication of right ventricular septal pacing.
据报道，部分患者长期起搏后会出现右心室心尖部起搏相关的心力衰竭。确切机制尚不清楚，但可能与右心室心尖部起搏诱发的左心室不同步有关。右心室间隔部起搏被认为较少导致左心室功能恶化，因为其左心室激动模式更接近正常。
我们报告了一例55岁突尼斯女性患者，其心室功能正常，因完全性房室传导阻滞植入双腔起搏器。右心室间隔部起搏诱发了严重的心室不同步、左心室射血分数显著下降以及充血性心力衰竭症状。升级为双心室装置后，症状和心室不同步减轻，左心室射血分数增加。
右心室间隔部起搏可诱发可逆性左心室功能障碍及继发于左心室不同步的心力衰竭。这种并发症仍然是右心室间隔部起搏不可预测的并发症。
