Scintigraphic perfusion defects due to right ventricular apical pacing: a pitfall in clinical cardiology.
Right ventricular apical pacing (RVAP) with a left bundle branch block on the electrocardiogram may result in regional wall motion abnormalities and decreased left ventricular function (LVF). Furthermore, perfusion defects in dipyridamole technetium-99m-methoxisobutylisonitrile ((99m)Tc-MIBI) myocardial perfusion imaging may occur despite a normal coronary angiogram. In a 68 years old patient, RVAP resulted in regional wall motion abnormalities, markedly decreased LVF and perfusion defects in dipyridamole (99m)Tc-MIBI myocardial perfusion imaging by single photon emission tomography (SPET). Coronary angiography excluded coronary heart disease. Reprogramming of the pacemaker resulted in physiologic activation of the ventricles. Echocardiography showed a normal LV systolic function. Repeated myocardial perfusion imaging was unremarkable. In conclusion, our case confirms thatRVAP may lead to scintigraphic perfusion defects and wall motion abnormalities despite a normal coronary angiogram and this differentiate between ischemia-induced perfusion defects.
Center for Cardiovascular Rehabilitation, HerzReha Bad Ischl, Gartenstrasse 9, 4820 Bad Ischl, Austria. robert.berent@aon.at.
Robert
R
Berent
Johann
J
Auer
Josef
J
Niebauer
Theresa
T
Berent
Helmut
H
Sinzinger
D000368:Aged; D016477:Artifacts; D002304:Cardiac Pacing, Artificial / Q000009:adverse effects*; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging*; D003937:Diagnosis, Differential; D006801:Humans; D008297:Male; D055414:Myocardial Perfusion Imaging / Q000379:methods*; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000209:etiology*