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- Title
Stymulacja układu bodźcoprzewodzącego z defibrylatorem po urwaniu mięśnia brodawkowatego po operacji kardiochirurgicznej -- opis przypadku.
- Authors
Szulik, M.; Suchodolski, A.; Jędrzejczyk-Patej, E.; Kowalska, W.; Lenarczyk, R.; Mazurek, M.; Sokal, A.; Kowalski, O.; Kalarus, Z.
- Abstract
BACKGROUND In patients requiring traditional stimulation, with heart failure, conduction system pacing (CSP) is very intensively studied. CASE SUMMARY A 70-year-old patient was admitted due to shortness of breath for 2-3 weeks (NYHA III/IV). Echocardiography revealed severe mitral valve regurgitation, prolapse of the posterior leaflet, enlargement of the LV with akinesia of the posterior wall and papillary muscle and LVEF of 30%. Coronary angiography did not reveal any significant narrowing of the arteries. The patient was qualified for emergency surgical treatment. The anterior mitral leaflet was removed under extracorporeal circulation, leaving a fragment of the leaflet with the string attachment, which was then attached to the mitral ring with valve sutures. Then a St Jude biological prosthesis was implanted. Intraoperatively, during extracorporeal circulation weaning, sudden cardiac arrest occurred (VF). After indirect and then direct cardiac massage, several defibrillations and adrenaline boluses, the heart rate normalised. Probably during direct cardiac massage the papillary muscle ruptured (Figure 1A -- arrow). Holter ECG revealed around 50 000 ventricular beats (LBBB morphology) (Figure 1B) and numerous sustained VT, as well as episodes of bradycardia requiring epicardial pacing. 3D Ensite ventricular extrasystole (VES) ablation within the RVOT was unsuccessful. Due to indications for a cardioverter-defibrillator and the need for intensive antiarrhythmic treatment the patient was qualified to a cardioverter-defibrillator with bundle branch pacing (CSP-D). To reduce arrhythmia, the patient was initially paced at 110/min, then 90/min and at discharge 80/min, with simultaneous use of intensive antiarrhythmic treatment (Figure 1C). Holter-ECG confirmed a significant reduction in ventricular arrhythmia. In the 3 months of follow-up CSP was up to 94%, without ventricular arrhythmias. CONCLUSIONS CSP seems to be a promising antiarrhythmic-treatment option for patients with VES with LBBB morphology with heart HF and unsuccessful ablation due to a mechanical trigger (for example ruptured muscle)
- Subjects
POLAND; CONFERENCES &; conventions; HEART conduction system; IMPLANTABLE cardioverter-defibrillators; HEART rupture; CARDIAC pacing; CARDIAC surgery
- Publication
Polish Heart Journal / Kardiologia Polska, 2024, Vol 82, p67
- ISSN
0022-9032
- Publication type
Article