Permanent pacemaker implantation with high pacing rate for treating refractory
right heart failure: a case report
#MMPMID41384085
Fang Y
; Pan W
; Zhou D
; Ge J
Eur Heart J Case Rep
2025[Dec]; 9
(12
): ytaf618
PMID41384085
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BACKGROUND: Current guidelines recommend that patients with systolic heart
failure should keep their resting heart rate (HR) at a relatively low level.
However, the optimal HR level for patients with right-sided heart failure (RHF)
remains unclear. CASE SUMMARY: A 43-year-old male diagnosed with desmin-related
cardiomyopathy 3 years ago has been repeatedly hospitalized over the past 5
months due to fatigue and severe oedema, with suboptimal control despite
high-dose diuretic medication. This patient, with an average HR of 55-60 b.p.m.,
was implanted with a pacemaker adjusted at 90 b.p.m. on this admission. Right
heart catheterization revealed immediate improvements in haemodynamics, including
increased cardiac output and decreased vena cava pressure and right atrial
pressure. At the 12-month follow-up, the patient was classified as New York Heart
Association Class I and did not experience recurrence of oedema, even while
taking low-dose diuretics (torasemide, 5?mg once daily, and spironolactone, 20?mg
once daily). DISCUSSION: A previous study has shown that personalized
acceleration of pacing rate in patients with heart failure with preserved
ejection fraction can effectively improve quality of life. In addition, patients
who undergo Fontan surgery can remain asymptomatic for decades, suggesting that
left ventricular pump function may be sufficient to sustain both systemic and
pulmonary circulation. Therefore, increasing HR can increase cardiac output,
promote forward flow from the right atrium and vena cava into the pulmonary
circulation, and reduce venous and right atrium pressures in patients with RHF
and normal left-sided heart function.
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