EpicardialCardiac pacing may lead to severe Mitral Regurgitation
by one of the following mechanisms: 1) Inappropriate Atrioventricular interval.
2) Myocardial ischemia due to fast heart rate may cause transient papillary muscle
dysfunction. 3) Right
Ventricular apical pacing may lead to Left Ventriculardyssynchrony in the presence of optimal Atrioventricular
synchrony.Acute severe
Mitral Regurgitation leading to acute severe hemodynamic deterioration is a reported
complication of Permanent Pacemaker insertion. Our case demonstrated acute severe
MR as a consequence of RV Pacing leading to acute hemodynamic deterioration, which
was relieved on withdrawal of pacing.Left Ventricular dyssynchrony can be relieved by reducing
the peacemaker rate or changing to biventricular pacing, this reduces the severity
of Mitral Regurgitation and improves the hemodynamics due to simultaneous activation
of left and right ventricles. This case
illustrates the acute and potentially dramatic effects of intra-Left Ventricular
dyssynchrony upon Mitral Valve function. Informed consent was obtained from the patient to report the case.Thus right ventricular pacing can
cause left ventricular dyssynchrony leading to worsening of Mitral Regurgitation.
It is important to pay attention to mode of pacing when evaluating Mitral Regurgitation
in patients with Right Ventricular pacemaker and unstable hemodynamics after initiation
of pacing.
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