Highlights a rare complication where left ventricular epicardial pacing in CRT-D can induce immediate torsades de pointes in patients with ischemic cardiomyopathy.
Alerts clinicians to possible torsades risk after BiV pacing switch in CRT-D; leaves open causal role of repolarization dispersion.
Cardiac resynchronization therapy with an implantable cardioverter-defibrillator (CRT-D) is the preferred treatment for patients with severe heart failure, dyssynchrony, and an increased risk of sudden cardiac death or for primary ventricular arrhythmia survivors. Rarely, left ventricular epicardial pacing can induce ventricular tachyarrhythmia rather than a beneficial effect. We describe an ischemic cardiomyopathy patient who underwent CRT-D therapy and developed sustained torsades de pointes (TdP) immediately after switching to biventricular pacing (BVP) mode. Here, TdP possibly developed owing to the change in the dispersion of repolarization of the left ventricle myocardium. The diagnosis and management of BVP-induced ventricular arrhythmia is discussed.
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Kaya et al. (2014) studied this question.
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