Heart Failure Improvement by Switching from RV to LV Pacing in Pacemaker-Induced Cardiomyopathy

Objectives: To evaluate the impact of switching from right ventricular (RV) pacing to left ventricular (LV) pacing on heart failure symptoms and cardiac function in patients with pacemaker-induced cardiomyopathy (PICM). Methodology: A randomized controlled trial was conducted with 150 patients, comparing outcomes between RV pacing and LV pacing via the coronary sinus lead. Primary endpoints included changes in left ventricular ejection fraction (LVEF), New York Heart Association (NYHA) functional class, hospitalizations, and quality of life (QoL), assessed using the Minnesota Living with Heart Failure Questionnaire (MLHFQ). Results: Patients who transitioned to LV pacing demonstrated a significant LVEF improvement (30% to 45%, p = 0.01) compared to those who remained on RV pacing (30% to 35%, p = 0.03). NYHA class improved from III to I in the LV pacing group, whereas the RV pacing group improved from III to II (p = 0.03). QoL scores (MLHFQ) showed greater improvement in the LV pacing group (60 to 40) compared to the RV pacing group (60 to 50, p = 0.02). Conclusion: Switching from RV pacing to LV pacing significantly improves cardiac function, symptom burden, and quality of life in PICM patients, highlighting LV pacing as a superior strategy for managing heart failure in this population.