Pacing Rate Acceleration in Right-Sided Heart Failure: Insight From an On-Off-On Clinical Course.

BACKGROUND

Treatment options remain limited for patients with right-sided heart failure (RHF) and severe tricuspid regurgitation (TR). Whether higher heart rate is beneficial in patients with RHF remains unclear.

CASE SUMMARY: A 74-year-old woman with RHF and severe TR experienced marked hemodynamic and symptomatic improvement after increasing her permanent pacing rate from 60 to 90 beats/min. At 3 months, rate reduction to 60 beats/min provoked symptom recurrence within 3 days; restoring the rate to 90 beats/min promptly relieved symptoms. At 6 months, left ventricular ejection fraction remained preserved and right ventricular size remained reduced, although TR remained severe.

DISCUSSION: This case suggests that increasing the pacing rate may optimize right-sided heart hemodynamics and improve symptoms in selected patients with RHF, although further validation is needed.

TAKE-HOME MESSAGE: An on-off-on response to pacing-rate adjustment-symptoms improving with higher rates and worsening at lower rates-supports a potential beneficial effect of heart rate elevation in selected patients with refractory RHF.