Case report: "A healthy woman with exertional dyspnea: Indication of a pacemaker or not?"

The selection of patients with chronotropic incompetence (CI) for cardiac pacing therapy remains challenging. Here, we present a case of a 40-year-old woman with severe exertional dyspnea. The exercise test revealed a blunted increase in the heart rate (HR) (maximum of 110 bpm). Her exercise capacity significantly improved under atrial stimulation at 170 bpm using a temporary pacing lead. Therefore, we implanted a rate-adaptive dual-chamber pacemaker with a blended sensor. During follow-up exercise capacity normalized, and she had no residual exertional dyspnea at 6 months. This case highlights the potential value for individual assessments of CI to identify clear indications for pacemaker implantation.

[Congenital heart disease in adults]. / Angeborene Herzfehler im Erwachsenenalter.

Adult congenital heart diseases are common, and nowadays treatable with convincing success. Interventional occlusion of septal defects, and percutaneous valve implantation become widely accepted. Considering trend analysis, surgical repair of malfunctioning valves is favored over valve replacement. Endocarditis prophylaxis is reserved for high risk situations.