Advanced Speckle-Tracking Echocardiography Could Play a Crucial Role in the Diagnosis of Post-Implanted Cardiomyopathy Associated with a Leadless Pacemaker System.

A leadless pacemaker (LP) is a modern alternative to a transvenous pacemaker, allowing certain complications to be avoided; however, some cannot be eliminated. To highlight the essential role of advanced speckle-tracking echocardiography (STE) in diagnosing pacing-induced cardiomyopathy (PICM) caused by an LP. A 79-year-old male, after LP implantation a year earlier, was admitted due to heart failure (HF). Left ventricular ejection fraction (LVEF) was 40%, global longitudinal strain (GLS) was -10%, and interventricular mechanical delay (IVMD) was 42 ms. All these parameters were significantly better before the operation. Myocardial work indices confirmed dyssynchrony due to the right ventricular (RV) stimulation pattern, and PICM was considered. To verify the impact of RV pacing on the LV, measurements were taken after restoring the native rhythm, showing an improvement in LVEF (45%), GLS (-13%), IVMD (7 ms), and myocardial work indices. After the next HF exacerbation with further deterioration of the LV function, a decision to convert the LP to a standard CRT-P system was made, with immediate relief in clinical symptoms and improved echocardiographic parameters. This case highlights the essential role of STE echocardiography in identifying the detrimental impact of RV pacing, diagnosing PICM, and selecting the appropriate treatment for patients with LPs.