Bradycardia-Associated Pulmonary Hypertension.

Background: Current guidelines identify pulmonary hypertension (PH) secondary to tachycardia-driven high-output conditions (eg, anemia, thyrotoxicosis), whereas bradycardia-induced PH-a critical low-flow phenotype-has not been addressed.

Case summary: We present a case of atrial fibrillation with slow ventricular response and PH. Pacemaker implantation was performed, and hemodynamic evaluation revealed that as the heart rate increased, pulmonary artery pressure progressively decreased. Postoperative cardiac function indices also improved.

Discussion: This case, along with existing evidence, suggests that pacing with an elevated heart rate may represent a therapeutic strategy for atrial fibrillation combined with bradycardia-induced PH.

Take-home messages: Profound bradycardia (<50 beats/min) may serve as a reversible contributor to PH. Personalized high pacing of the heart rate can enhance cardiac output, thereby reducing pulmonary vascular resistance and lowering pulmonary artery pressure.