Pacing-induced left ventricular dysfunction - Relationship with coronary perfusion

In a patient admitted with symptomatic complete heart block, a DDD pacemake r was implanted. Prior to implantation, echocardiography showed normal left ventricular function. Shortly after implantation, acute congestive heart f ailure developed with extensive regional hypo- and akinetic segments in the anteroseptal, anterolateral and apical region. Subsequent perfusion imagin g with methoxyiso-buticeisonitrite (MIBI) at rest demonstrated hypoperfusio n in the same regions while coronary angiography showed normal epicardial c oronary vessels. Thus, impaired regional coronary flow can be associated wi th cardiac stimulation, inducing marked deterioration of left ventricular f unction.