Abstract
BACKGROUND: Atrioventricular (AV) block is a potential complication of orthotropic heart transplantation (OHT). The optimal cardiac pacing method is largely unexplored in patients after OHT. CASE SUMMARY: We present a patient with AV block after OHT in whom right ventricular pacing resulted in pacing-induced cardiomyopathy (PICM). Left ventricular function was restored with left bundle branch pacing. DISCUSSION: AV block is an uncommon complication after OHT that requires ventricular pacing. Ventricular dyssynchrony induced by right ventricular pacing may be associated with increased risk for PICM in OHT recipients. Cardiac physiologic pacing should be considered as the primary pacing strategy in this population. TAKE-HOME MESSAGES: OHT recipients may be at increased risk for PICM. Left bundle branch pacing is an effective strategy for both prevention and treatment of PICM.