Pacing-Induced Cardiomyopathy Following Permanent Pacemaker Implantation: A Case Report and Review of Management Strategies.

Pacing-induced cardiomyopathy (PICM) is a well-documented complication of long-term right ventricular pacing (RVP) leading to left ventricular systolic dysfunction and heart failure. We describe a 58-year-old woman with a history of complete heart block who underwent single-chamber pacemaker implantation. Eleven months later, she presented with New York Heart Association (NYHA) class IV heart failure and bilateral pleural effusions. Investigations revealed a significant drop in ejection fraction from 55% to 25%, with no other identifiable cause of heart failure. She was diagnosed with PICM and successfully managed with medical therapy and upgrade to cardiac resynchronisation therapy pacemaker (CRT-P). Her clinical symptoms and left ventricular function improved significantly. This case highlights the importance of early recognition of PICM and the benefit of CRT-P upgrade in patients with high RVP burden.