His Bundle Pacing for Pacing-Induced Cardiomyopathy: Indonesian Experience and Future Prospects: A Case Report

Abstract

Bradycardia is characterized by a slower heart rate caused by a malfunction in the electrical system that regulates the heart rate. This Bradycardia condition affects approximately one in every 600 people worldwide. Permanent pacemaker (PPM) implantation is suitable for patients with bradycardia and other rhythm abnormalities that require a pacemaker. However, some patients fail to tolerate conventional right ventricular (RV) pacing resulting in pacing-induced cardiomyopathy (PICM). His Bundle Pacing (HBP) prevents the occurrence of PICM. Proper management is important for the patient’s outcome. This HBP technique is being used for the first time in Surabaya, which creates a lot of interest in reporting such a case. A 79-years-old Southeast Asian female was referred from a peripheral facility to Dr. Soetomo hospital with symptomatic bradycardia and hypertension. She decreased of consciousness for 4 days and sometimes dizzy without chest pain, dyspnea, or palpitation. The patient had 1 cardiac arrest and returned to spontaneous circulation after cardiopulmonary resuscitation on the 2^nd day of treatment in the peripheral facility. She had fainted several times in one year before being hospitalized. In ER, she felt weak. Physical examination showed BP = 145/83 mmHg with dopamine support. The ECG suggested a sinus rhythm 66 times/minute with 2^nd degree AV block Mobitz 1 with bigeminy PAC. CXR showed cardiomegaly. Low potassium and albumin level was found. In evaluation, ECG showed paroxysmal atrial fibrillation with rapid ventricular response, and returned to sinus bradycardia. Temporary pacemaker was installed. She was treated and observed in ICCU for 2 days. Afterwards, we installed His Bundle Pacing. Permanent pacemaker implantation has been on the rise recently as the population has gotten older more quickly. For patients with bradycardia, permanent pacemaker implantation is appropriate; however, some patients are unable to tolerate right ventricular (RV) pacing, which can result in pacing-induced cardiomyopathy (PICM), which results in a more than 10% decline in left ventricular ejection fraction (LVEF) after PPM implantation. Due to the preservation of physiological ventricle activation and absence of ventricular dyssynchrony, the implantation of HBP is superior to conventional RV pacing. HBP significantly reduces heart failure hospitalization and mortality when compared to RV pacing. This symptomatic bradycardia was caused by sick sinus syndrome and was treated with HBP. It is found that HBP was associated with reduced heart failure hospitalization.