Isolated right ventricular failure and abnormal hemodynamics caused by right ventricular pacing are reversed with cardiac resynchronization therapy Milena.

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Presentation transcript:

Isolated right ventricular failure and abnormal hemodynamics caused by right ventricular pacing are reversed with cardiac resynchronization therapy Milena A. Gebska, MD, PhD, Michael C. Giudici, MD, FHRS, James Rossen, MD, Jeffrey S. Wilson, MD, Gardar Sigurdsson, MD, Barry London, MD, PhD, Kanu Chatterjee, MB, FRCP (Lond), FRCP (Edin), MACP HeartRhythm Case Reports Volume 1, Issue 4, Pages 182-185 (July 2015) DOI: 10.1016/j.hrcr.2015.01.021 Copyright © 2015 Heart Rhythm Society Terms and Conditions

Figure 1 Left: baseline. ECGs of a symptomatic patient show left bundle branch block (A) and incomplete right bundle branch block (B). Right: Five years after dual-chamber pacemaker implantation. Volume-rendered dual-source computed tomographic images show plaque-free left dominant system (C) and nondominant right coronary artery (D). Four-chamber views obtained during systole (E) and diastole (F) show right-sided chamber enlargement and poor fractional shortening. Right ventricular pacemaker lead creates metal artifacts. LA = left atrium; LV = left ventricle; RA = right atrium; RV = right ventricle. HeartRhythm Case Reports 2015 1, 182-185DOI: (10.1016/j.hrcr.2015.01.021) Copyright © 2015 Heart Rhythm Society Terms and Conditions

Figure 2 Effect of biventricular pacing on right-sided hemodynamics in a symptomatic patient with preserved left ventricular ejection fraction. Five years after dual-chamber pacemaker implantation, right atrial pressure was elevated and rose further with inspiration, consistent with Kussmaul sign and underlying primary right ventricular failure. Two months after cardiac resynchronization therapy (CRT) upgrade, right-sided filling pressures normalized, Kussmaul sign was absent, but baseline low cardiac index did not respond to resynchronization therapy. HeartRhythm Case Reports 2015 1, 182-185DOI: (10.1016/j.hrcr.2015.01.021) Copyright © 2015 Heart Rhythm Society Terms and Conditions

Figure 3 Effect of biventricular pacing on heart rate variability and sympathetic tone. A: Within the first month of cardiac resynchronization therapy (CRT), the majority of resting heart rates stayed within the range of 80–90 bpm. Six months later, periods of lower heart rates (60–70 bpm) significantly increased. B: Representative 24-hour densitometry plots show very subtle increases in heart rate variability and increases in lower-frequency rates after CRT. HeartRhythm Case Reports 2015 1, 182-185DOI: (10.1016/j.hrcr.2015.01.021) Copyright © 2015 Heart Rhythm Society Terms and Conditions