The case is presented of an elderly woman with normal left ventricular (LV)
systolic function and VVI pacing complicated by severe congestive heart fa
ilure.
The symptoms and findings of congestive heart failure became refractory to
medical treatment and resolved with the upgrade of the VVI to a DDD system.
Right heart catheterization during VVI pacing showed increased mean pulmon
ary capillary wedge and right atrial pressures both being normalized under
DDD pacing. This case report illustrates the need to consider permanent phy
siological pacing in elderly patients, even in presence of normal LV systol
ic function, to ensure AV synchrony when the atrium can be paced, since dia
stolic LV dysfunction is quite common in these subjects.