Transvenous dual site left ventricular pacing plus biventricular pacing for the management of refractory ventricular tachycardia

Abstract

This is a case report of a male patient with nonischemic cardiomyopathy who had severely depressed left ventricular systolic function and functional class III congestive heart failure (CHF). He also had left bundle branch block (LBBB) and recurrent ventricular tachycardia (VT). Though the patient's CFH functional class improved after implantation of a transvenous biventricular ICD system, recurrent VT episodes required the initiation of amiodarone. After an improved condition for 28 months, recurrent VT episodes led to multiple consecutive ICD shocks, which constituted an electrical storm and a battery status of elective replacement indicator (ERI). The recurrent VT episodes were suppressed with intravenous amiodarone and lidocaine. As Radiofrequency ablation was declined by the patient, a new left ventricular (LV) lead was transvenously added, providing biventricular and dual site LV pacing. After this intervention the arrhythmia subsided and the intravenous antiarrhythmic medications were stopped. No episodes of sustained VT leading to ICD shocks were observed for the following 9 months. The events in this case suggest that dual site LV pacing with biventricular pacing could be an alternative strategy for the management of refractory VT.

Mid-term outcomes of triple-site vs. conventional cardiac resynchronization therapy: A preliminary study

“…Pappone et al [11] found that this mode of stimulation was superior to singlesite left ventricular pacing in terms of acute hemodynamic performance of the ventricle and its electrical synchrony. Until very recently, the only data on triple-site biventricular pacing came from anecdotal case-reports, which suggested that this type of stimulation can improve clinical status and suppress ventricular arrhythmias in HF patients [12][13][14]. In our previous study we demonstrated that dual left-single right cardiac resynchronization is a safe method and can be performed successfully in the majority of CRT candidates [7].…”

Biventricular with Multi-Site Left-Ventricular Pacing for the Management of Refractory Ventricular Tachycardia in a Patient with Narrow Complex QRS – Case Report

“…Patients with narrow-complex were not included in this study. Acosta et al [9] described a case in which a patient with non-ischemic cardiomyopathy and LBBB developed an electrical storm despite having a biventricular ICD implanted and being on antiarrhythmic therapy [9]. Adding a new LV lead to provide multi-site LV pacing on top of BVP resulted in suppression of the ventricular arrhythmia, narrowing of the QRS complex, and improvement of HF functional class.…”

Transvenous Dual Site Left Ventricular Pacing to Lower Elevated Pacing Thresholds

“…Dual‐site LV pacing has been described in the past using both epicardial and endocardial leads. It has been associated with decreased inter‐ and intra‐ventricular delay, 1 greater increases in peak dP/dt and pulse pressure, 2 improvement in ventricular tachycardias, 3 and in the largest series, the Trip‐HF study, decreased LV end‐systolic volume and increased LV ejection fraction 4 . However, in that study, only patients with permanent atrial fibrillation were eligible as it required plugging the second LV lead in the atrial port and pacing in a DDD mode with a 25‐ms atrioventricular interval to effect dual site LV pacing.…”