Cardiac Resynchronization Therapy as Rescue Therapy in End‐Stage Heart Failure: Illustration by Three‐Dimensional Speckle Tracking Strain Echocardiography

Abstract

We report the case of a 73-year-old man admitted for refractory heart failure following implantation of a dual-chamber pacemaker. Three-dimensional (3D) echocardiography with speckle tracking area strain identified severe left ventricular (LV) dysfunction and LV dyssynchrony following right ventricular pacing. As the patient's clinical condition rapidly worsened despite optimal medical treatment, a cardiac resynchronization therapy (CRT) pacemaker was successfully implanted as rescue therapy. Symptoms rapidly regressed and echocardiographic assessment following CRT demonstrated an immediate improvement in LV systolic function, confirmed at 9-month follow-up with evidence of reverse remodeling. New imaging technologies such as 3D echocardiography with speckle tracking area strain may help to identify and follow up patients who will benefit from CRT as rescue therapy.

The effectiveness of cardiac resynchronization therapy for patients with New York Heart Association class IV non‐ambulatory heart failure

“…No trials have reported on the usefulness of LV dyssynchrony prior to CRT implantation in patients with NAHF. One case report described a 73‐year‐old man with a pacemaker who was admitted for refractory heart failure [16]. A speckle tracking strain identified severe LV dysfunction and LV dyssynchrony following RV pacing.…”

Bradyarrhythmias and Physiologic Pacing in the ICU

“…There have now been multiple cases showing that this hemodynamic benefit can be significant enough to liberate patients tethered to vasopressors, inotropes, or even ECMO and achieve stability enough to leave the intensive care unit (Table 5). [69][70][71][72][73][74][75][76] We describe the case of a patient in our ICU on multiple vasopressors, inotrope, and IABP with wide paced morphology who could not be weaned until BiV upgrade (Figure 2). Another retrospective study from Japan, examined 50 patients that were all ICU level patients with wide QRS who were unable to be discharged from intensive care (due to requiring IABP or inotropes).…”

The Role of Echocardiography in the Optimization of Cardiac Resynchronization Therapy: Current Evidence and Future Perspectives

“…The suitability of echocardiographic parameters to improve the response rate to CRT has been controversial. Speckle tracking echocardiography (STE) has been reported as a useful imaging method to detect CRT responders [ 3 , 4 ]. Atrioventricular (AV) and interventricular (VV) delay optimization can augment ventricular function in CRT and is usually performed utilizing echocardiography [ 5 ].…”