Central Illustration: Proposed Mechanism of Pacemaker-induced Cardiomyopathy.

In complete atrioventricular heart block, the impulse is not propagated from the atria to the ventricles. Electronic pacemakers (left) provide an electric impulse with retrograde conduction through slow conducting myocardium (black arrows). This can lead to electrical and mechanical dyssynchrony, decreased systolic function, fibrosis and adverse remodeling. A biological pacemaker (right) provides antegrade conduction via His-purkinje network and can prevent or rescue the deleterious changes seen in pacing induced cardiomyopathy.