Cardiac Resynchronization Therapy With Defibrillator for Acromegalic Cardiomyopathy With Left Bundle Branch Block

BACKGROUND: Heart failure is a cardiovascular complication of acromegaly associated with poor prognosis. Treatment directed solely at acromegaly does not reliably improve cardiac function. CASE SUMMARY: A 56-year-old man was diagnosed with acromegaly and acromegalic cardiomyopathy. After 6 months of somatostatin analog therapy combined with guideline-directed medical therapy for heart failure, his left ventricular ejection fraction and hormone level improved. Subsequently, the patient developed acute heart failure triggered by sustained ventricular tachycardia. The patient received cardiac resynchronization therapy with defibrillator. During follow-up, the patient had no further heart failure exacerbations; echocardiography showed left ventricular ejection fraction increased to 48%. His left ventricular synchrony improved markedly. DISCUSSION: Normalization of growth hormone levels does not fully reverse myocardial involvement in this patient with advanced acromegalic cardiomyopathy. In this patient, cardiac resynchronization therapy significantly improved left ventricular synchrony and outcome. TAKE-HOME MESSAGE: This case highlights the importance of timely and appropriate cardiac resynchronization therapy with defibrillator implantation in patients with advanced acromegalic cardiomyopathy.