Worsening Heart Failure From Decreased Atrioventricular Synchronization Rate of a Leadless Pacemaker

Kazuku Ishihara, MD; Takenori Ikoma, MD; Makoto Sano, MD; Terumori Satoh, MD; Keisuke Iguchi, MD; Atsushi Sakamoto, MD; Kenichiro Suwa, MD; Yoshihisa Naruse, MD; Hayato Ohtani, MD; Yuichiro Maekawa, MD

doi:10.1016/j.jaccas.2025.103862

JACC: Case Reports (Jul 2025)

Worsening Heart Failure From Decreased Atrioventricular Synchronization Rate of a Leadless Pacemaker

Kazuku Ishihara, MD,
Takenori Ikoma, MD,
Makoto Sano, MD,
Terumori Satoh, MD,
Keisuke Iguchi, MD,
Atsushi Sakamoto, MD,
Kenichiro Suwa, MD,
Yoshihisa Naruse, MD,
Hayato Ohtani, MD,
Yuichiro Maekawa, MD

Affiliations

Kazuku Ishihara, MD: Division of Cardiology, Internal Medicine Ⅲ, Hamamatsu University School of Medicine, Hamamatsu, Japan
Takenori Ikoma, MD: Division of Cardiology, Internal Medicine Ⅲ, Hamamatsu University School of Medicine, Hamamatsu, Japan
Makoto Sano, MD: Address for correspondence: Dr Makoto Sano, Division of Cardiology, Internal Medicine Ⅲ, Hamamatsu University School of Medicine, 1-20-1 Handayama, Chuo-ku, Hamamatsu City, Shizuoka 431-3192, Japan.; Division of Cardiology, Internal Medicine Ⅲ, Hamamatsu University School of Medicine, Hamamatsu, Japan
Terumori Satoh, MD: Division of Cardiology, Internal Medicine Ⅲ, Hamamatsu University School of Medicine, Hamamatsu, Japan
Keisuke Iguchi, MD: Division of Cardiology, Internal Medicine Ⅲ, Hamamatsu University School of Medicine, Hamamatsu, Japan
Atsushi Sakamoto, MD: Division of Cardiology, Internal Medicine Ⅲ, Hamamatsu University School of Medicine, Hamamatsu, Japan
Kenichiro Suwa, MD: Division of Cardiology, Internal Medicine Ⅲ, Hamamatsu University School of Medicine, Hamamatsu, Japan
Yoshihisa Naruse, MD: Division of Cardiology, Internal Medicine Ⅲ, Hamamatsu University School of Medicine, Hamamatsu, Japan
Hayato Ohtani, MD: Division of Cardiology, Internal Medicine Ⅲ, Hamamatsu University School of Medicine, Hamamatsu, Japan
Yuichiro Maekawa, MD: Division of Cardiology, Internal Medicine Ⅲ, Hamamatsu University School of Medicine, Hamamatsu, Japan

DOI: https://doi.org/10.1016/j.jaccas.2025.103862
Journal volume & issue: Vol. 30, no. 17
p. 103862

Abstract

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Background: Atrioventricular synchronous pacing with a leadless pacemaker is a therapy used in patients with atrioventricular block. However, atrial oversensing may cause an increase in heart rate, with resulting atrioventricular dyssynchrony. Case Summary: A 90-year-old woman, who was treated with a leadless pacemaker 2 years earlier for a complete atrioventricular block, developed congestive heart failure. The electrocardiogram revealed an increase in heart rate with atrioventricular dyssynchronous pacing and a decrease in atrioventricular synchronization rate. A manual atrial mechanical test indicated dyssynchronized atrioventricular pacing secondary to atrial mechanical oversensing. Discussion: This case of heart failure exacerbation resulted from 1) the increase in heart rate with atrioventricular dyssynchrony caused by atrial mechanical oversensing and 2) the dyssynchronous pacing resulting from pacing-induced cardiomyopathy. Take-Home Messages: Atrioventricular synchronization can vary with changes in cardiac structure and hemodynamics. It is important to assess atrioventricular synchrony repeatedly in electrocardiograms or rate histograms in the device.

Published in JACC: Case Reports

ISSN: 2666-0849 (Online)
Publisher: Elsevier
Country of publisher: United States
LCC subjects: Medicine: Internal medicine: Specialties of internal medicine: Diseases of the circulatory (Cardiovascular) system
Website: https://www.journals.elsevier.com/jacc-case-reports

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