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Case Report
 
Acute pacing-induced cardiomyopathy
Talal Alzahrani1, Sripooja Satya1, Marco Mercader2
1MD, Department of Internal Medicine, George Washington University, Washington, DC, USA.
2MD, FACC, FHRS, Division of Cardiology, George Washington University, Washington, DC, USA.

Article ID: 100031CRINTTA2016
doi:10.5348/crint-2016-31-CR-12

Address correspondence to:
Talal Alzahrani
Department of Internal Medicine, George Washington University
Washington, DC
USA
401 12th St South, Apt 2110, zip code: 22202, Arlington, VA, US

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How to cite this article:
Alzahrani T, Satya S, Mercader M. Acute pacing-induced cardiomyopathy. Case Rep Int 2016;5:48–53.


Abstract
Introduction: Pacing-induced cardiomyopathy (PICM) is defined as a 10% reduction in the left ventricular ejection fraction over several months to a year after pacemaker implantation, resulting in an ejection fraction of less than 50%. Nonetheless, other causes of cardiomyopathy should be excluded to diagnose patients with this condition.
Case Report: A 59-year-old male presented with a third-degree heart block and underwent pacemaker implantation with right ventricular pacing. Subsequently, he manifested with an acute heart failure exacerbation and a reduced ejection fraction within two months of pacemaker implantation. Consequently, he underwent further workup to exclude causes of dilated cardiomyopathy such as acute coronary syndrome, sarcoidosis, hemochromatosis, granulomatosis with polyangiitis, and eosinophilic myocarditis. His left heart catheterization showed worsening in his ejection fraction without any significant coronary stenosis. He had an endomyocardial biopsy, which showed fibroblast proliferation and fibrosis with no evidence of any infiltrative cardiomyopathy. This patient was diagnosed with pacing-induced cardiomyopathy because other causes of cardiomyopathy were ruled out. Thus, his cardiac pacemaker device was upgraded to Biventricular pacing device with implantable cardioverter defibrillator.
Conclusion: This report describes a patient with a severe acute form of pacing-induced cardiomyopathy and discusses the prevention and therapy of this condition.

Keywords: Cardiomyopathy, Pacing, Pacemaker


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Author Contributions
Talal Alzahrani – Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Sripooja Satya – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Marco Mercader – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Guarantor of submission
The corresponding author is the guarantor of submission.
Source of support
None
Conflict of interest
Authors declare no conflict of interest.
Copyright
© 2016 Talal Alzahrani et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.



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