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Cardiac Resynchronization Therapy Defibrillator Implantation in Atrial Fibrillation

Age Gender Occupation Working Diagnosis 76 Years Male Retired Florist Heart Failure and Atrial Fibrillation with Rapid Ventricular Rate History Since 1980 this patient was treated periodically with venosections as a result of hemochromatosis. He had received medical therapy for hypertension since 1985 and was diagnosed with hypertensive nephropathy in 1994. He had a non-Q anterior myocardial infarction in 1996, with following postinfarction angina pectoris. The…

Atrial Fibrillation Therapy in Refractory Heart Failure

Age Gender Occupation Working Diagnosis 65 Years Male Office Worker Hypokinetic Dilated Cardiomyopathy with Permanent Atrial Fibrillation and Severe Mitral Valve Regurgitation History A 65-year-old man, affected by permanent atrial fibrillation for more than 10 years experienced worsening mitral valve regurgitation and maladaptive left ventricle remodeling. These conditions led to hypokinetic dilated cardiomyopathy with severe reduction of left ventricular systolic function and repeated hospitalizations for acute…

Prevention of Effective Cardiac Resynchronization Therapy by Frequent Premature Ventricular Contractions in a Patient with Nonischemic Cardiomyopathy

Age Gender Occupation Working Diagnosis 65 Years Male Clothing Shop Owner Frequent Idiopathic Premature Ventricular Contractions from the Posteromedial Papillary Muscle Aggravate Symptoms of Heart Failure and Prevent Resynchronization Therapy History In 2002 the patient was diagnosed with Global Initiative for Chronic Obstructive Lung Disease stage II chronic obstructive pulmonary disease and in 2004 with first-degree atrioventricular block. In June 2011 he was admitted for decompensated…

Managing Ventricular Tachycardia: Total Atrioventricular Block After Ablation in a Patient with Nonischemic Dilated Cardiomyopathy

Age Gender Occupation Working Diagnosis 42 Years Female Beautician Life-Threatening Electrical Storm from Sustained Monomorphic Ventricular Tachycardia Requiring External Defibrillation History In September 2000 the patient was referred to a cardiologist because of premature ventricular contractions. The 12-lead surface electrocardiogram (ECG) showed sinus rhythm with atypical right bundle branch block (RBBB), a fragmented QRS, and negative T-waves in III, aV F and V 1-3 . Echocardiography,…

The Importance of Maintaining a High Percentage of Biventricular Pacing

Age Gender Occupation Working Diagnosis 54 Years Male Farmer Nonischemic Cardiomyopathy History The patient is a 54-year-old man with a history of a nonischemic dilated cardiomyopathy. He was initially referred for consideration of a third procedure for atrial fibrillation. He had undergone pulmonary vein isolation procedures 1 year and 3 months previously. In addition to pulmonary vein isolation, linear ablation of both the left and right…

Loss of Left Ventricular Pacing Capture Detected by Remote Monitoring

Age Gender Occupation Working Diagnosis 76 Years Male Retired High School Teacher Dilated Cardiomyopathy History The patient was a 76-year-old man with heart failure, left bundle branch block (LBBB), and paroxysmal atrial fibrillation. Comments The patient with symptomatic heart failure (New York Health Association [NYHA] III) was referred for cardiac resynchronization therapy defibrillator (CRT-D) implantation. He had a dilated cardiomyopathy with left ventricular disfunction (ejection fraction…

Left Ventricular Quadripolar Lead in Phrenic Nerve Stimulation: It Is Better to Prevent Than to Treat

Age Gender Occupation Working Diagnosis 59 Years Male Electrician Dilated Cardiomyopathy and Heart Failure History In 2010 the patient reported dyspnea with New York Heart Association (NYHA) class II, then class III. A nonischemic dilated cardiomyopathy was diagnosed. The surface electrocardiogram (ECG) showed a complete left bundle branch block (LBBB) and the echocardiography a left ventricular ejection fraction (LVEF) of 25% and a left ventricular end-diastolic…

Atrioventricular Optimization by Transthoracic Echocardiography in a Patient with Interatrial Delay

Age Gender Occupation Working Diagnosis 71 Years Male Retired Congestive Heart Failure and Post–Cardiac Resynchronization Therapy Status History The patient had a history of acute myocardial infarction with triple vessel disease and underwent coronary artery bypass surgery. Comments This patient had congestive heart failure with an ischemic cause. Current Medications The patient was taking aspirin 80 mg daily, candesartan 8 mg daily, furosemide 40 mg daily,…

Robotically Assisted Lead Implantation for Cardiac Resynchronization Therapy in a Reoperative Patient

Age Gender Occupation Working Diagnosis 79 Years Male Retired Chronic Right Ventricular Pacing with Falling Left Ventricular Ejection Fraction and Progressive Heart Failure History The patient has an extensive cardiac history, beginning with a myocardial infarction and subsequent coronary artery bypass and three grafts in 1988. In 2002, he underwent a reoperative three-vessel bypass. He was diagnosed with sick sinus syndrome in 2001 that required the…

Novel Wireless Technologies for Endocardial Cardiac Resynchronization Therapy

Age Gender Occupation Working Diagnosis 68 Years Male Retired Nonresponder to Cardiac Resynchronization Therapy Evaluated for Wireless Left Ventricular Endocardial Cardiac Stimulation to Deliver Cardiac Resynchronization Therapy History A 68-year-old man previously underwent implantation of a cardiac resynchronization therapy defibrillator (CRT-D) device (February 2007) after a class I indication for CRT at the time—symptomatic drug-refractory ischemic-based heart failure disease, New York Heart Association (NYHA) class III,…

Left Ventricular Endocardial Pacing in a Patient with an Anomalous Left-Sided Superior Vena Cava

Age Gender Occupation Working Diagnosis 67 Years Male Builder Heart Failure (Ischaemic Cardiomyopathy) and Pacemaker Dependence After Atrioventricular Node Ablation History The patient had a complex past medical history. He underwent bioprosthetic aortic valve replacement in 2006 related to infective endocarditis with consequent severe aortic regurgitation and had moderately impaired left ventricular systolic function (left ventricular ejection fraction [LVEF] 45%-50%). Coronary angiography did not show significant…

Endocardial Left Ventricular Lead: High Approach

Age Gender Occupation Working Diagnosis 65 Years Male Retired Heart Failure History The patient was a 65-year-old retired man seeking treatment for dilated cardiomyopathy with normal coronary arteries for about 10 years. Risk factors are dyslipidemia and obesity (91 kg, 173 cm). Two procedures of ablation for atrial fibrillation and atrial tachycardia were performed 6 and 2 years earlier. One year previously, a new episode of…

Role of Cardiac Computed Tomography Before Implant : Diagnosis of a Prominent Thebesian Valve as an Obstacle to Left Ventricular Lead Deployment in Cardiac Resynchronization Therapy

Age Gender Occupation Working Diagnosis 54 Years Female Business Prominent Thebesian Valve History The patient had a medical history of hypertrophic cardiomyopathy with progression to the dilated phase of cardiomyopathy (New York Heart Association class III) and conduction abnormalities, including a prolonged QRS duration of 154 msec with right bundle branch block (RBBB) and left anterior fascicular block. Her family history was positive for hypertrophic cardiomyopathy…

Video-Assisted Thoracotomy Surgery for Implantation of an Epicardial Left Ventricular Lead

Age Gender Occupation Working Diagnosis 80 Years Female Retired Congestive Heart Failure History Nonischemic cardiomyopathy with a left ventricular ejection fraction of 15% to 20%, down from 30% in a span of 6 months, and New York Heart Association (NYHA) class III congestive systolic heart failure was diagnosed 5 months before the current admission. The patient also had a long history of chronic anemia that predates…

Persistent Left Superior Vena Cava : Cardiac Resynchronization Therapy with Left-Sided Venous Access

Age Gender Occupation Working diagnosis 55 Years Female Housewife Idiopathic Cardiomyopathy History This patient had complete heart block, with 30% left ventricular ejection fraction (LVEF) visualized on echocardiography. A temporary pacemaker wire was inserted into the right ventricle via femoral venous access. Coronary artery angiography was performed, ruling out coronary artery disease. The patient was scheduled for a biventricular pacemaker. Current Medications The patient was taking…

Persistent Left Superior Vena Cava: Utility of Right-Sided Venous Access for Coronary Sinus Lead Implantation

Age Gender Occupation Working Diagnosis 78 Years Male Retired Heart Failure Requiring Cardiac Resynchronization Therapy History This patient with a history of mechanical aortic valve replacement, New York Heart Association class III heart failure, 25% left ventricular ejection fraction, and a left bundle branch block with a QRS of 160 ms was addressed for implantation of a biventricular pacemaker. You’re Reading a Preview Become a Clinical…

Utility of Active Fixation Lead in Unstable Left Ventricular Lead Positions in the Coronary Sinus for Left Ventricular Stimulation

Age Gender Occupation Working Diagnosis 66 Years Male Retired Teacher Ventricular Tachycardia and Recurrent Heart Failure History The patient had recurrent hospital admissions for heart failure despite optimal tolerable medical therapy. He had a left ventricular ejection fraction of 25% and mechanical dyssynchrony on tissue Doppler echocardiogram. He also had documented nonsustained ventricular tachycardia and paroxysmal atrial fibrillation on Holter monitoring. Current Medications The patient was…

Mapping the Coronary Sinus Veins Using an Active Fixation Lead to Overcome Phrenic Nerve Stimulation

Age Gender Occupation Working Diagnosis 69 Years Male Retired Government Clerk Ischemic Cardiomyopathy and Ventricular Tachycardia History A 69-year-old man had underlying complete heart block and chronic atrial fibrillation, diabetes mellitus, and hypertension. He had a single-chamber pacemaker implanted in 2003 for complete heart block. He developed ventricular tachycardia 8 years previously, which required cardioversion. He was referred for further management. Current Medications The patient was…

Successful Cardiac Resynchronization Therapy Implantation: When to Consider the Middle Cardiac Vein

Age Gender Occupation Working Diagnosis 58 Years Male Office Worker Heart Failure Exacerbation History A 58-year-old male office worker with a long-standing history of cardiomyopathy, likely after an episode of viral myocarditis 20 years previously, sought treatment for worsening shortness of breath and functional deterioration. The patient was mildly obese and not in acute respiratory distress. He had a dual-chamber pacing system because of intermittent heart…

Right Ventricular Pacing–Related Cardiomyopathy

Age Gender Occupation Working Diagnosis 62 Years Male Physician Progressive Left Ventricular Dysfunction Resulting from Chronic Right Ventricular Pacing History A 62-year-old nonsmoking man was referred for upgrade of his dual-chamber pacing system to a cardiac resynchronization therapy (CRT) pacing system. The dual-chamber pacing system had been implanted 4 years earlier. The initial indication for cardiac pacing was complete heart block that developed roughly 8 hours…