Right Ventricular Apical (RVA) Pacing-Induced Cardiomyopathy Disguised As Ischemic Cardiomyopathy: A Case Report

Cardiac pacing is an effective treatment for patients with symptomatic bradycardia. The majority of patients tolerate right ventricular apical (RVA) pacing, which remains the standard of care for patients who have a normal ejection fraction (EF). However, a significant minority experience adverse left ventricular (LV) remodeling and a decline in EF. In this case report, we describe a patient with chronic RVA pacing and an EF of 20% with hypokinesis of mid-septal and inferior wall segments who was scheduled for mitral valve replacement, Cox-Maze, left atrial appendage clipping, and possible coronary artery bypass graft (CABG). After bi-ventricular pacing, EF improved to 45% due to improved function of the mid-septal and inferior wall segments.