Reversible Biventricular Dysfunction Due to Right Ventricular Pacing in a Patient With Prior Cancer Treatment
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Date
2025
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Abstract
Background: We report the case of a 54-year-old woman with a history of breast cancer treated with chemotherapy, surgery, and thoracic radiotherapy in 2007, who developed pacing-induced cardiomyopathy (PICM) after right ventricular pacing.Case Summary: The patient initially presented with symptomatic trifascicular block and underwent single-chamber pacemaker implantation due to bilateral subclavian vein stenosis, with atrial sensing (VDD mode). Eight months postimplantation, she presented with heart failure symptoms and new-onset biventricular systolic dysfunction. Ventricular pacing was 100% owing to complete atrioventricular block. Coronary angiography was unremarkable, and catheterization confirmed elevated filling pressures without pericardial constrictive physiology.Discussion: Given the patient's lack of candidacy for cardiac resynchronization therapy, medical treatment was optimized, leading to significant functional improvement and recovery of biventricular function within 6 months.Take-Home Message: This case highlights the potential reversibility of pacing-induced cardiomyopathy with optimal medical therapy when cardiac resynchronization therapy is not feasible.