Why the study?
Symptomatic patients with significant LVSD require tailored treatment, as developing FMR and LBBB contribute to clinical deterioration and worse prognosis despite OMT.
Targeted device interventions such as transvenous mitral annuloplasty and cardiac resynchronization therapy can be combined synergistically to optimize symptoms in patients with heart failure.
May support tailored device strategies in refractory LVSD with FMR and LBBB; leaves open prospective validation.
Background Symptomatic patients with significant left ventricular systolic dysfunction (LVSD) require a tailored treatment approach. Both functional mitral regurgitation (FMR) and left bundle branch block (LBBB) can develop, contributing to clinical deterioration, and worse prognosis despite optimal medical therapy (OMT). Case summary We report the case of a symptomatic 60-year-old man on OMT with LVSD and significant FMR. His symptoms and FMR initially improved following transvenous mitral annuloplasty using the Carillon® Mitral Contour System® annuloplasty device. However, he subsequently developed LBBB with associated reduction in exercise capacity, for which he underwent cardiac resynchronization therapy, and ensuing symptom improvement and stabilization. Discussion Our case describes how targeted device interventions can be combined synergistically to optimize patient symptoms.
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Jamil et al. (2019) studied this question.
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