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- Title
THE IMPORTANCE OF ADEQUATE DEVICE PROGRAMMING IN CARDIAC RESYNCHRONIZATION THERAPY.
- Authors
Dobai, Bernadett-Miriam; Sus, Ioana; Dobreanu, Dan
- Abstract
Background: Among patients with heart failure, those with an ejection fraction of less than 35% and left bundle branch block have an indication for cardiac resynchronization therapy (CRT). The aim is to attain atrioventricular, interventricular and intraventricular synchrony at least 95% of the time. Objective: Our purpose is to highlight the importance of an adequate device programming in a patient with cardiac resynchronization therapy. Material and method: We present the case of a 41 years old male patient admitted to the Cardiology Department of the Emergency Institute for Cardiovascular Diseases and Transplant Târgu Mure?. The patient had dilated cardiomyopathy secondary to severe aortic regurgitation on a bicuspid aortic valve, for which he underwent Bentall procedure, and let bundle branch block with a QRS duration of 160 ms. The left ventricular systolic function was severely depressed, with an ejection fraction of 19%. As he has been on optimal medical treatment for heart failure, including carvedilol, eplerenone, sacubitril and valsartan, the patient underwent CRT implantation. A quadripolar left ventricular lead was placed in a postero-lateral epicardial vein but could not be advanced distally due to anatomical limitations, with the proximal electrodes close to the coronary sinus ostia. The pacemaker was programmed in DDD mode, with detection on all three leads (right atrium, right ventricle -RV, left ventricle-LV) and biventricular pacing, LV only, with a sensed atrio-ventricular delay of 80 msec. Three days after implantation, the device interrogation showed a CRT percentage of 63% and Holter monitoring revealed long episodes of non-paced ventricular rhythm. The patient complained of abnormal heart beats when standing. On device interrogation, when standing, the LV lead sensed on the proximal electrodes the atrial electrical activity, which inhibited ventricular pacing. Results: The pacemaker was reprogrammed in order to prevent detection of atrial electrical activity on the LV lead, allowing an optimal percent of CRT. Conclusion: CRT is only efficient when optimally programmed and close follow-up of this patient in specialized centers is necessary.
- Subjects
CARDIAC pacing; AORTIC valve insufficiency; HEART failure patients; HEART beat; THERAPEUTICS; DILATED cardiomyopathy
- Publication
Acta Medica Marisiensis, 2019, Vol 65, p41
- ISSN
2068-3324
- Publication type
Article