09 June 2019 : Case report
Biventricular Pacing Going Along with Acute Hemodynamic Response in a Patient with Huge Anterior Wall Aneurysm – Importance of Pacing Viable Myocardium
Unusual clinical course, Unusual or unexpected effect of treatmentSpyridon Liosis1BDEF*, Evgeny Lyan1AB, Amr Abdin1EF, Ben Brüggemann1BC, Stefan A. Lange1D, Julia Vogler1DE, Christian H. Heeger1D, Kivanc Yalin2EF, Roland R. Tilz1A, Charlotte Eitel1AB
Am J Case Rep 2019; 20:810-815
BACKGROUND: Response to cardiac resynchronization therapy (CRT) is variable among patients. Extensive scar tissue burden has been characterized as a negative predictor of significant response. Whereas mid-term and long-term response has been thoroughly investigated in randomized clinical trials; however, little is known about acute hemodynamic effects of biventricular pacing.
CASE REPORT: We report a case of an elderly female patient with severe ischemic cardiomyopathy and a large anterior wall aneurysm, who received right ventricular and biventricular pacing during ablation of incessant pleomorphic ventricular tachycardia. During the procedure, biventricular pacing was associated with a 20% acute increase in systolic blood pressure compared to right ventricular pacing, although there was no acute or long-term effect on left ventricular function.
CONCLUSIONS: The acute hemodynamic effect of CRT in our patient suggests an effect of CRT even in patients with negative predictors of CRT response such as severe ischemic cardiomyopathy with a large aneurysm. Although no marked increase in left ventricular function might be observed, the acute effect of CRT might contribute to stabilization of heart failure in these patients.
Keywords: cardiac resynchronization therapy, Heart Aneurysm, Myocardial Ischemia, Aged, 80 and over, Catheter Ablation, Dyspnea, Electrocardiography, Hemodynamics, Imaging, Three-Dimensional, Multimorbidity, Prognosis, Risk Assessment, Tachycardia, Ventricular, Treatment Outcome
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