Can a pacemaker cause some temporarily negative effect in left ventricular output?

I’m a 54 yr old male who underwent isolated tricuspid valve repair in November of 2014. Had dual chamber pacemaker installed in April of this year for complete heart block with coronary sinus pacing lead. On recent echocardiogram, right side of heart and tricuspid valve normal but the LVEF all of the sudden is a little low at 47% with mild global hypokinesis of left ventricle noted on report (all chamber sizes and wall thicknesses noted to be normal) Two echoes in Jan/Feb before pacemaker showed 55-60% LVEF with good wall motion. No family history of cardiomyopathy etc. Exercise 7 day/week with no breathing issues or edema to-date.

1. Could pacemaker and change of heart flow have caused some temporarily negative effect in left ventricle output?
2. Is there any way to make a determination of what’s going on other just call it idiopathic?

Submitted by Alan from Atlanta, Georgia on 09/10/2015

by Abdi Rasekh, MD

From your description you have a biventricular pacemaker. You mentioned a coronary sinus lead which implies 3 leads and a biventricular device. If you have a dual chamber pacemaker then it could be upgraded to a biventricular pacemaker. Your ejection fraction has marginally decreased and it does not affect your exercise tolerance. You have to make sure all echos were read by same physician and possibly compare images to confirm the real decrease in ejection fraction rather than a difference in interpretation. There is no single test that can explain this decrease in ejection fraction. However reversible causes such as underline coronary artery disease need to be ruled out.