02 February 2018 : Case report
A Patient with Left Bundle Branch Block and Persistent Atrial Fibrillation Treated with Cardiac Catheter Ablation and Pharmacologic Cardiac Resynchronization Therapy without the Use of an Implantable Cardiac Device
Unusual or unexpected effect of treatment, Rare coexistence of disease or pathologyHideyuki Hasebe1ABCDE*
Am J Case Rep 2018; 19:123-127
BACKGROUND: Left bundle branch block (LBBB) is associated with atrial fibrillation (AF) and systolic heart failure, which can be treated with cardiac resynchronization therapy (CRT) that includes an implantable cardiac device (ICD). However, in some patients, LBBB may vary with heart rate, and during episodes of AF in LBBB, aberrant ventricular conduction, or wide QRS complex tachycardia (Ashman beats) can occur. This report is a case of LBBB treated with pharmacologic CRT, without the use of an ICD.
CASE REPORT: A 68-year-old man presented with persistent AF and systolic heart failure. Serial electrocardiograms (ECGs) showed AF and mixed narrow (116 ms) and wide (152 ms) QRS duration of LBBB. Echocardiography showed a left ventricular ejection fraction (LVEF) of 30%. Catheter ablation for AF resulted in the restoration of sinus rhythm. The patient was treated with step-wise decreasing doses of amiodarone, from 200 mg to 75 mg daily, and step-wise increasing doses of bisoprolol, from 3.75 mg to 5.0 mg daily, which effectively slowed heart rate, inhibited aberrant cardiac conduction due to LBBB, reduced the symptoms of heart failure, and improved LVEF to 60%, despite persistent sinus bradycardia and the inability of the heart rate to increase during activity (chronotropic incompetence).
CONCLUSIONS: This report of a case of AF associated with LBBB shows that pharmacologic CRT can restore sinus rhythm following catheter ablation and can reduce heart rate and treat heart failure without the use of an ICD.
Keywords: Atrial Fibrillation, cardiac resynchronization therapy, Heart Failure
22 September 2022 : Case reportRare Case of Persistently Depressed T Lymphocyte Subsets After SARS-CoV-2 Infection
Am J Case Rep In Press; DOI: 10.12659/AJCR.937760
22 September 2022 : Case reportCentral Retinal Vein Occlusion After Discontinuation of Rivaroxaban Therapy in a Young Patient with COVID-1...
Am J Case Rep In Press; DOI: 10.12659/AJCR.937739
19 September 2022 : Case reportInhaled Nitric Oxide in Acute Severe Pulmonary Hypertension and Severe Acute Respiratory Distress Syndrome ...
Am J Case Rep In Press; DOI: 10.12659/AJCR.937147
27 Sep 2022 : Case reportCompound Heterozygote Mutation in the SMPD1 Gene Leading to Nieman-Pick Disease Type A
Am J Case Rep In Press; DOI: 10.12659/AJCR.937220
26 Sep 2022 : Case reportAn Infant Presenting with Interstitial Lung Disease Diagnosed Later as Hunter Syndrome: A Case Report
Am J Case Rep In Press; DOI: 10.12659/AJCR.937527
26 Sep 2022 : Case reportAcute Intermittent Porphyria: Complete Phenotype in a Patient with p.Arg173Trp Variant in Thailand
Am J Case Rep In Press; DOI: 10.12659/AJCR.937695
Most Viewed Current Articles
13 Jul 2022 : Case reportWhistling Scrotum: An Unusual Presentation of Pneumomediastinum in the Setting of an Open Scrotal Wound
Am J Case Rep 2022; 23:e936441
23 Feb 2022 : Case reportPenile Necrosis Associated with Local Intravenous Injection of Cocaine
Am J Case Rep 2022; 23:e935250
06 Dec 2021 : Case reportLipedema Can Be Treated Non-Surgically: A Report of 5 Cases
Am J Case Rep 2021; 22:e934406