Beneficial triple-site cardiac resynchronization in a patient supported with an intra-aortic balloon pump for end-stage heart failure.
Bottom Line: Implantation of a triple-site cardiac resynchronization system and complex heart failure treatment brought a significant improvement, return to home activity and 17-month survival.The patient died due to heart failure aggravation.Within this time he was rehospitalized and successfully treated twice for an electrical storm.
Affiliation: Institute of Cardiology, Warsaw, Poland.
The authors present the case of a 62-year-old male patient with an implantable cardioverter-defibrillator and end-stage heart failure supported with an intra-aortic balloon pump. Implantation of a triple-site cardiac resynchronization system and complex heart failure treatment brought a significant improvement, return to home activity and 17-month survival. The patient died due to heart failure aggravation. Within this time he was rehospitalized and successfully treated twice for an electrical storm.
No MeSH data available.
Related in: MedlinePlus
Mentions: A 62-year-old patient with CHF after anterior and posterior wall myocardial infarction (MI) with a dual chamber cardioverter-defibrillator (ICD), after two percutaneous coronary interventions, was admitted to the department due to significant CHF progression and recurrent ventricular tachycardias (VTs) resulting in numerous ICD discharges. On admission, the patient presented with pulmonary congestion, peripheral edema and systolic arterial blood pressure permanently < 80 mm Hg. Left ventricle ejection fraction (LVEF) was 10% approximately and post MI left bundle branch-like block with QRS time 180 ms was present. Due to the potential proarrhythmic effect inotropic agents were found to be dangerous in arrhythmic storm and an IABP was inserted. An IABP support, loop diuretics and amiodarone infusion provided transient circulation stability without VT recurrence. Then, a decision was made to upgrade the patient's ICD to a TriV system. Two bipolar LV leads were implanted in the posterolateral and great cardiac veins; pacing thresholds were 2.8 V and 5.0 V with respect for leads’ stability and the leads were switched to a Y bipolar connector (the position of system leads is shown in Figure 1, native and paced electrograms are shown in Figures 2 and 3 respectively). A defibrillation test was not done as contraindicated in NYHA IV CHF. No complications were observed and the patient's functional status improved. The IABP was removed four days after the procedure. Oral pharmacotherapy and gradual smooth exercise training were introduced. The patient left the intensive care unit on day 11. Three weeks later he was discharged home with NYHA class II/III and he joined a cardiac ambulatory rehabilitation program subsequently. Peak VO2 = 10.4 ml/kg/min increased to 12.3 ml/kg/min 8 months later and LVEF increased within the same period from 10% to 30%. Nine and ten months after the TriV implantation the patient developed two electrical storm (ES) events and was urgently re-hospitalized, treated successfully with intravenous amiodarone, isotonic fluid and electrolyte administration and empiric use of mexiletine p.o. Because of battery depletion due to numerous discharges, the device was electively replaced 1 year after TriV implantation. Pacing parameters remained stable. The patient died due to heart failure progression 17 months after the TriV method had been introduced.
No MeSH data available.