Standard cardiac resynchronization therapy with a second right ventricular lead for severe right ventricular heart failure in 2 patients with repaired.

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Standard cardiac resynchronization therapy with a second right ventricular lead for severe right ventricular heart failure in 2 patients with repaired tetralogy of Fallot Tadanobu Irie, MD, Yoshiaki Kaneko, MD, Koji Kurosawa, MD, Tadashi Nakajima, MD, Masahiko Kurabayashi, MD HeartRhythm Case Reports Volume 2, Issue 1, Pages 76-79 (January 2016) DOI: 10.1016/j.hrcr.2015.10.009 Copyright © 2016 Heart Rhythm Society Terms and Conditions

Figure 1 Data in case 1. A and G: 12-lead electrocardiograms before and after the cardiac resynchronization therapy (CRT), respectively. The QRS duration of 164 milliseconds before the implantation shortened to 140 milliseconds during CRT. B and H: 2-dimensional speckle tracking–derived displacement curves of right ventricle (RV) and septal segments in an apical 4-chamber view before and after the implantation, respectively. Positive and negative values indicate the location of each sample relative to baseline, inside and outside the RV cavity. Red and green dotted arrows indicate negative peak of the curves of RV free wall (RVFW) and apical septal wall (SEP), respectively. Contraction delay of RVFW relative to the SEP (indicated by horizontal bidirectional arrows) was 228 milliseconds, whereas the delay was improved by 72 milliseconds after CRT. C and D: Activation maps of the RV septum and RVFW, respectively, during sinus rhythm with right bundle branch block (RBBB) in a right anterior oblique view. Left-to-right transseptal wavefront breakthrough from the RV midseptum, with propagation to the basal lateral wall with a delay of 129 milliseconds, compared with that of the RV septal wall. E and F: Fluoroscopic views in left and right oblique projections showing lead positions. I and J: Abdominal computed tomography before and after the implantation, respectively. CS = coronary sinus, RA = right atrium, RVA = RV apex. HeartRhythm Case Reports 2016 2, 76-79DOI: (10.1016/j.hrcr.2015.10.009) Copyright © 2016 Heart Rhythm Society Terms and Conditions

Figure 2 Data in case 2. A and E: 12-lead electrocardiograms before and after the implantation, respectively. QRS duration shortened from 194 to 172 milliseconds after the CRT. B and F: 2-dimensional speckle tracking–derived displacement curves of RV and septal segments in an apical 4-chamber view before and after the CRT, respectively. Red and blue dotted arrows indicate the negative peaks of the curves of the RVFW and mid SEP, respectively. The contraction delay of RVFW relative to the SEP was markedly improved from 259 to 0 milliseconds. C and D: Fluoroscopic views in left and right oblique projections showing lead positions. Other abbreviations are as in Figure 1. HeartRhythm Case Reports 2016 2, 76-79DOI: (10.1016/j.hrcr.2015.10.009) Copyright © 2016 Heart Rhythm Society Terms and Conditions