Congestive heart failure treated by the upgrade from VVI to DDD pacing

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.