Korean Circulation Journal

The Korean Society of Cardiology (대한심장학회)
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Rapid and Potent Antiarrhythmic Effect of Cardiac Resynchronization Therapy in a Patient with Advanced Dilated Cardiomyopathy and a Large Ventricular Arrhythmia Burden

  • Jeon, Dong Sub (Division of Cardiology, Department of Internal Medicine, Dong-A University College of Medicine) ;
  • Park, Jong Sung (Division of Cardiology, Department of Internal Medicine, Dong-A University College of Medicine)
  • Received : 2016.10.09
  • Accepted : 2017.01.09
  • Published : 2017.07.31
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Abstract

We report a case demonstrating a rapid and potent antiarrhythmic effect of biventricular pacing. A 67-year-old male patient with dilated cardiomyopathy was admitted for heart failure. The initial surface electrocardiogram revealed a left bundle branch block with a QRS complex duration of 200 ms. Echocardiographic examination revealed a left ventricular ejection fraction of 16%, a left ventricular end-diastolic dimension of 91 mm, and marked interventricular dyssynchrony. Continuous rhythm monitoring revealed frequently-recurring non-sustained monomorphic ventricular tachycardia (VT). Polymorphic VT, which persisted for 27 seconds, occurred on the third day after admission, and the R on T phenomenon recurred every two to three days thereafter. Optimal medical therapy for four weeks failed to suppress the recurrence of ventricular arrhythmias or ameliorate heart failure. Cardiac resynchronization therapy was initiated for an anticipated antiarrhythmic effect of biventricular pacing. Three days after the initiation of biventricular pacing, the ventricular arrhythmias disappeared almost completely.

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References

  1. Meinertz T, Hofmann T, Kasper W, et al. Significance of ventricular arrhythmias in idiopathic dilated cardiomyopathy. Am J Cardiol 1984;53:902-7. https://doi.org/10.1016/0002-9149(84)90522-8
  2. Ponikowski P, Voors AA, Anker SD, et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur J Heart Fail 2016;18:891-975. https://doi.org/10.1002/ejhf.592
  3. Kies P, Bax JJ, Molhoek SG, et al. Effect of left ventricular remodeling after cardiac resynchronization therapy on frequency of ventricular arrhythmias. Am J Cardiol 2004;94:130-2. https://doi.org/10.1016/S0002-9149(04)01054-9
  4. Di Biase L, Gasparini M, Lunati M, et al. Antiarrhythmic effect of reverse ventricular remodeling induced by cardiac resynchronization therapy: the InSync ICD (Implantable Cardioverter-Defibrillator) Italian Registry. J Am Coll Cardiol 2008;52:1442-9. https://doi.org/10.1016/j.jacc.2008.07.043
  5. de Bakker JM, van Capelle FJ, Janse MJ, et al. Reentry as a cause of ventricular tachycardia in patients with chronic ischemic heart disease: electrophysiologic and anatomic correlation. Circulation 1988;77:589-606. https://doi.org/10.1161/01.CIR.77.3.589
  6. Hamdan MH, Zagrodzky JD, Joglar JA, et al. Biventricular pacing decreases sympathetic activity compared with right ventricular pacing in patients with depressed ejection fraction. Circulation 2000;102:1027-32. https://doi.org/10.1161/01.CIR.102.9.1027
  7. Kies P, Bax JJ, Molhoek SG, et al. Effect of cardiac resynchronization therapy on inducibility of ventricular tachyarrhythmias in cardiac arrest survivors with either ischemic or idiopathic dilated cardiomyopathy. Am J Cardiol 2005;95:1111-4. https://doi.org/10.1016/j.amjcard.2005.01.029
  8. Ermis C, Seutter R, Zhu AX, et al. Impact of upgrade to cardiac resynchronization therapy on ventricular arrhythmia frequency in patients with implantable cardioverter-defibrillators. J Am Coll Cardiol 2005;46:2258-63. https://doi.org/10.1016/j.jacc.2005.04.067
  9. Fish JM, Brugada J, Antzelevitch C. Potential proarrhythmic effects of biventricular pacing. J Am Coll Cardiol 2005;46:2340-7. https://doi.org/10.1016/j.jacc.2005.08.035
  10. McSwain RL, Schwartz RA, DeLurgio DB, Mera FV, Langberg JJ, Leon AR. The impact of cardiac resynchronization therapy on ventricular tachycardia/fibrillation: an analysis from the combined Contak-CD and InSync-ICD studies. J Cardiovasc Electrophysiol 2005;16:1168-71. https://doi.org/10.1111/j.1540-8167.2005.40719.x
  11. Cha YM, Chareonthaitawee P, Dong YX, et al. Cardiac sympathetic reserve and response to cardiac resynchronization therapy. Circ Heart Fail 2011;4:339-44. https://doi.org/10.1161/CIRCHEARTFAILURE.110.959858
  12. Russo AM, Stainback RF, Bailey SR, et al. ACCF/HRS/AHA/ASE/HFSA/ SCAI/SCCT/SCMR 2013 appropriate use criteria for implantable cardioverter-defibrillators and cardiac resynchronization therapy: a report of the American College of Cardiology Foundation appropriate use criteria task force, Heart Rhythm Society, American Heart Association, American Society of Echocardiography, Heart Failure Society of America, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Computed Tomography, and Society for Cardiovascular Magnetic Resonance. Heart Rhythm 2013;10:e11-58. https://doi.org/10.1016/j.hrthm.2013.01.008
  13. Pinski SL, Fahy GJ. The proarrhythmic potential of implantable cardioverter-defibrillators. Circulation 1995;92:1651-64. https://doi.org/10.1161/01.CIR.92.6.1651
  14. Runsio M, Kallner A, Kallner G, Rosenqvist M, Bergfeldt L. Myocardial injury after electrical therapy for cardiac arrhythmias assessed by troponin-T release. Am J Cardiol 1997;79:1241-5. https://doi.org/10.1016/S0002-9149(97)00090-8
  15. Goldenberg I, Moss AJ, Hall WJ, et al. Causes and consequences of heart failure after prophylactic implantation of a defibrillator in the multicenter automatic defibrillator implantation trial II. Circulation 2006;113:2810-7. https://doi.org/10.1161/CIRCULATIONAHA.105.577262
  16. Poole JE, Johnson GW, Hellkamp AS, et al. Prognostic importance of defibrillator shocks in patients with heart failure. N Engl J Med 2008;359:1009-17. https://doi.org/10.1056/NEJMoa071098

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