Cardiac Resynchronization Therapy in Patients with Right Ventricular Pacing-Induced Cardiomyopathy

Methods and Results: We reviewed the charts of patients who received a CRT device for RV pacing-induced cardiomyopathy. We assessed the effects of CRT on LV function, recovery, and other response parameters. From September 2005 through February 2009, 21 patients (13 men; aged 63 +/- 9 years) underwent a treatment upgrade to a CRT system. Before the dual-chamber pacemaker was implanted, the LV ejection fraction (LVEF) was 53 +/- 2.3%. After pacing, the LVEF was 31.2 +/- 3.8%, the LV end-diastolic dimension (LVEDD) was 5.8 +/- 0.5 cm, and B-type natriuretic peptide (BNP) levels were 426 +/- 149 pg/mL. The duration of pacing before documentation of pacing-induced cardiomyopathy was 3.8 +/- 1.5 months. All the patients had been on a stable medical regimen for at least 2 months. After the upgrade to CRT, the follow-up time was 4.9 +/- 0.9 months. Sixteen patients (76%) reported a significant improvement in their symptoms. After the CRT upgrade, the LVEF increased to 37.4 +/- 9.0% (P < 0.01 vs pre-CRT). The LVEDD decreased to 5.0 +/- 1.0 cm (P = 0.03 vs pre-CRT), and BNP levels decreased to 139 +/- 92 pg/mL (P = 0.08 vs pre-CRT). Conclusion: A CRT upgrade is an effective treatment for RV pacing-induced cardiomyopathy and should be implemented as soon as the diagnosis is established. Unfortunately, about 24% of our patients did not respond to the upgrade. (PACE 2010; 37-40).