Permanent pacemaker implantation with high pacing rate for treating refractory right heart failure: a case report

Current guidelines recommend that patients with systolic heart failure should keep their resting heart rate (HR) at a relatively low level. However, the optimal HR level for patients with right-sided heart failure (RHF) remains unclear.

A 43-year-old male diagnosed with desmin-related cardiomyopathy 3 years ago has been repeatedly hospitalized over the past 5 months due to fatigue and severe oedema, with suboptimal control despite high-dose diuretic medication. This patient, with an average HR of 55–60 b.p.m., was implanted with a pacemaker adjusted at 90 b.p.m. on this admission. Right heart catheterization revealed immediate improvements in haemodynamics, including increased cardiac output and decreased vena cava pressure and right atrial pressure. At the 12-month follow-up, the patient was classified as New York Heart Association Class I and did not experience recurrence of oedema, even while taking low-dose diuretics (torasemide, 5 mg once daily, and spironolactone, 20 mg once daily).

A previous study has shown that personalized acceleration of pacing rate in patients with heart failure with preserved ejection fraction can effectively improve quality of life. In addition, patients who undergo Fontan surgery can remain asymptomatic for decades, suggesting that left ventricular pump function may be sufficient to sustain both systemic and pulmonary circulation. Therefore, increasing HR can increase cardiac output, promote forward flow from the right atrium and vena cava into the pulmonary circulation, and reduce venous and right atrium pressures in patients with RHF and normal left-sided heart function.