md-medicaldata

Authors

Borislav Dolamić¹, Ana Aladin Dolamić², Anđelko Hladis¹, Dragoslava Živkov Šaponja³, Anastazija Stojšić Milosavljević<sup>3

1</sup>Vojna bolnica Novi Sad, Prote Mihaldžića 18, 21131 Novi Sad, Srbija
²Institut za zdravstvenu zaštitu dece i omladine Vojvodine, Hajduk Veljkova 10, 21101 Novi Sad, Srbija
³Institut za kardiovaskularne bolesti Vojvodine, Put doktora Goldmana 4, 21204 Sremska Kamenica, Srbija

 

UDK: : 615.817.035.2
616.127-021

The paper was received / Rad 01.04.2026.

Accepted / Rad prihvaćen: 01.05.2026.

 

Correspondence to:

Borislav Dolamić
Vojna bolnica Novi Sad, Prote Mihaldžića 18,
21131 Novi Sad
e-mail: boradolamic@yahoo.com

 

 

Sažetak

 

 

Uvod: Pacemaker-indukovana kardiomiopatija predstavlja značajnu komplikaciju hronične desnoventrikularne stimulacije, nastalu usled električne i mehaničke disinhronije. Ista može dovesti do progresivne sistolne disfunkcije leve komore i sledstvenog razvoja srčane insuficijencije. Najčešće se javlja kod pacijenata sa visokim procentom ventrikularne stimulacije, naročito kod atrioventrikularnog bloka koji zahteva kontinuiranu stimulaciju. Prikaz slučaja: Muškarac starosti 86 godina, vojni penzioner, hospitalizovan je zbog novootkrivene dekompenzovane srčane insuficijencije sa simptomima dispneje i smanjene tolerancije napora koji su prisutni tokom prethodna dva meseca. Zbog atrioventrikularnog bloka drugog stepena tip 2:1 2019. godine ugrađen mu je dvokomorni pejsmejker. Godinu dana pre prijema ehokardiografski je registrovana očuvana sistolna funkcija leve komore sa ejekcionom frakcijom od 50%. Tokom aktuelne hospitalizacije sprovedeni su ehokardiografski pregled, laboratorijska analiza, dvadesetčetvoročasovni Holter elektrokardiogram i radiološka dijagnostika. Ehokardiografskim pregledom pri prijemu evidentirana je dilatacija leve komore, smanjenja sistolna funkcija leve komore koja je procenjenu na 23 %, globalna hipokontraktilnost, paradoksalni pokreti interventrikularnog septuma i značajno snižen globalni longitudinalni strain. Registrovani su i znaci dijastolne disfunkcije sa povišenim pritiscima punjenja, teška dilatacija leve pretkomore i umerena mitralna regurgitacija. Funkcija desne komore bila je očuvana, uz sekundarnu tešku trikuspidnu regurgitaciju i plućnu hipertenziju. Laboratorijski je registrovana povišena vrednost N-terminalnog prohormona moždanog natriuretskog peptida uz hroničnu bubrežnu insuficijenciju trećeg stadijuma. Holter elektrokardiogram pokazao je dominantan ritam pejsmejkera sa visokim procentom ventrikularne stimulacije, epizodama atrijalne fibrilacije i čestim ventrikularnim ekstrasistolama. Na osnovu kliničkog toka i nalaza postavljena je dijagnoza pacemaker-indukovane kardiomiopatije. Učinjeno je reprogramiranje uređaja sa ciljem smanjenja desnoventrikularnog pacinga, ali bez značajnijeg kliničkog i ehokardiografskog poboljšanja nakon mesec dana praćenja, zbog čega je indikovana nadogradnja na kardijalnu resinhronizacionu terapiju. Zaključak: Pacemaker-indukovana kardiomiopatija predstavlja potencijalno reverzibilnu komplikaciju hronične desno­ventrikularne stimulacije. Pravovremeno prepoznavanje, redovno ehokardiografsko praćenje i procena procenta ventrikularnog pacinga imaju ključni značaj za rano lečenje i sprečavanje progresije srčane insuficijencije. Kardijalna resinhronizaciona terapija predstavlja standardni terapijski pristup kod razvijene bolesti.

 

Ključne reči:

pejsmejker; kardiomiopatija; srčana insuficijencija; kardijalna resinhronizaciona terapija; desnoventrikularna stimulacija.

 

 

 

Abstract

 

Introduction: Pacemaker-induced cardiomyopathy represents a significant complication of chronic right ventricular pacing caused by electrical and mechanical dyssynchrony. It may lead to progressive left ventricular systolic dysfunction and the development of heart failure. It most commonly occurs in patients with a high percentage of ventricular pacing, particularly in patients with atrioventricular block requiring continuous stimulation. Case presentation: An 86-year-old male military retiree was hospitalized due to newly diagnosed decompensated heart failure with symptoms of dyspnea and reduced exercise tolerance present during the previous two months. In 2019, a dual-chamber pacemaker was implanted because of second-degree atrioventricular block type 2:1. One year before admission, echocardiography demonstrated preserved left ventricular systolic function with an ejection fraction of 50%. During the current hospitalization, echocardiographic examination, laboratory analysis, 24-hour Holter electrocardiography, and radiological diagnostics were performed. Echocardiography at admission revealed left ventricular dilatation, reduced left ventricular systolic function estimated at 23%, global hypokinesia, paradoxical interventricular septal motion, and markedly reduced global longitudinal strain. Signs of diastolic dysfunction with elevated filling pressures, severe left atrial dilatation, and moderate mitral regurgitation were also observed. Right ventricular function was preserved, with secondary severe tricuspid regurgitation and pulmonary hypertension. Laboratory findings demonstrated elevated levels of N-terminal pro-brain natriuretic peptide along with stage III chronic kidney disease. Holter electrocardiography showed a dominant pacemaker rhythm with a high percentage of ventricular pacing, episodes of atrial fibrillation, and frequent ventricular extrasystoles. Based on the clinical course and diagnostic findings, a diagnosis of pacemaker-induced cardiomyopathy was established. The device was reprogrammed with the aim of reducing right ventricular pacing; however, no significant clinical or echocardiographic improvement was observed after one month of follow-up, and therefore an upgrade to cardiac resynchronization therapy was indicated. Conclusion: Pacemaker-induced cardiomyopathy is a potentially reversible complication of chronic right ventricular pacing. Timely recognition, regular echocardiographic follow-up, and assessment of the percentage of ventricular pacing are of key importance for early treatment and prevention of heart failure progression. Cardiac resynchronization therapy represents the standard therapeutic approach in advanced disease.

 

Key words:

pacemaker; cardiomyopathy; heart failure; cardiac resynchronization therapy; right ventricular pacing.

 

 

 

 

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