Ventricular Tachycardia Induced by Biventricular Pacing in Patient with Severe Ischemic Cardiomyopathy
Introduction: Cardiac resynchronization therapy (CRT) is a new alternative which affords symptomatic improvement in two‐thirds of patients who exhibit medically refractory congestive heart failure (CHF) as well as significant prolongation of the QRS duration (>135 msec). As more experience with C...
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Published in | Journal of cardiovascular electrophysiology Vol. 16; no. 6; pp. 655 - 658 |
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Main Authors | , , , , , , |
Format | Journal Article |
Language | English |
Published |
350 Main Street , Malden , MA 02148-5018 , USA , and 9600 Garsington Road , Oxford OX4 2DQ , UK
Blackwell Science Inc
01.06.2005
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Subjects | |
Online Access | Get full text |
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Summary: | Introduction: Cardiac resynchronization therapy (CRT) is a new alternative which affords symptomatic improvement in two‐thirds of patients who exhibit medically refractory congestive heart failure (CHF) as well as significant prolongation of the QRS duration (>135 msec). As more experience with CRT accrues, unexpected complications of this promising therapy may become apparent. Herein, we describe a patient with severe ischemic cardiomyopathy and refractory CHF who developed incessant ventricular tachycardia (VT) after the initiation of biventricular pacing.
The patient is a 75‐year‐old man who suffered an inferior myocardial infarction 6 years before presenting for CRT. He underwent a three‐vessel CABG in 1997. Subsequently, episodes of near syncopal sustained VT developed, for which he received a dual chamber ICD. In 2001 he developed refractory CHF and ECG revealed LBBB with a QRS duration of 195 msec. Shortly after the initiation of biventricular pacing, the patient developed multiple episodes of drug resistant monomorphic VT that could be terminated only transiently by ICD therapies.
Ultimately, the only intervention, which proved to be effective in eliminating VT episodes, was inactivation of LV pacing. Despite subsequent therapeutic regimen of sotalol, lidocaine, tocainide, and quinidine all subsequent attempts to reactivate LV pacing resulted in prompt VT recurrence.
Conclusion: This case represents a clear example of CRT induced proarrhythmia, which required inactivation of LV pacing for effective acute management. Such an intervention should be considered in CRT patients who exhibit a notable increase in drug refractory VT episodes. |
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Bibliography: | istex:05F6E3082DB3E6E0A90B92BF7271653BA30E2243 ark:/67375/WNG-WSRD56S7-K ArticleID:JCE40764 Manuscript received 14 November 2004; Revised manuscript received 2 December 2004; Accepted for publication 8 December 2004. ObjectType-Case Study-2 SourceType-Scholarly Journals-1 ObjectType-Feature-4 content type line 23 ObjectType-Report-1 ObjectType-Article-3 |
ISSN: | 1045-3873 1540-8167 |
DOI: | 10.1111/j.1540-8167.2005.40764.x |