Cardiac Resynchronization Therapy in Cardiogenic Shock: A Case-Based Discussion

Figures

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  Figure 1. Electrocardiogram on admission. A 12-lead electrocardiogram was obtained on admission. A sinus rhythm with fusion complexes can be observed. There is a right axis deviation with a left bundle branch block. QRS was 154 ms, heart rate was 82 beats per minute, PR interval was 180 ms, and QTc was 500 ms.

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  Figure 2. Chest X-ray findings. A single anteroposterior portable chest X-ray was obtained. No acute intrathoracic processes were observed.

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  Figure 3. Post-procedure chest X-ray. A portable anteroposterior chest x-ray was obtained after the procedure. An implantable cardioverter-defibrillator pace/sense/defibrillator lead was placed in the right ventricle septal apex where appropriate function was demonstrated. The other leads can be seen at the right atrium and the coronary venous sinus. The leads were sutured to the pectoralis muscle with a suture sleeve. Adequate hemostasis was ensured and the pocket was flushed with an antibiotic solution. The leads were connected to the generator and the system was placed into the pre-pectoral pocket. The wound was closed with layers of absorbable suture. The procedure was tolerated well and there were no complications.

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  Figure 4. Electrocardiogram on follow-up. An electrocardiogram was obtained during outpatient follow-up. A QRS of 130 ms was seen with a ventricular-paced rhythm, Furthermore, the patient had a heart of 77 beats per minute, a PR of 176 ms, and a QTc of 513 ms.