July 25, 2008Pacing and Clinical Electrophysiology

Cardiac Resynchronization Therapy in a Patient with a Mitral Annuloplasty Device

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Structured PICO

Population

1 patient (n=1), 58-year-old man with high-degree mitral regurgitation, prior annuloplasty device (MONARC) insertion, pacing-induced inter- and intraventricular asynchrony, and worsening heart failure.

Intervention

Biventricular ICD insertion with left ventricular approach via the coronary sinus over the MONARC device

Outcome

QRS duration, clinical status, and 6-minute walking testsurrogate

Biventricular ICD can be successfully implanted via the coronary sinus over a MONARC mitral annuloplasty device to treat pacing-induced asynchrony.

Implication

Feasible in select patients with mitral annuloplasty devices; hypothesis-generating for biventricular pacing in pacing-induced asynchrony.

Abstract

We present a case of a 58-year-old man. Due to high-degree mitral regurgitation an anuloplasty device (MONARCtrade mark) was inserted. During continuous pacing, inter- and intraventricular asynchrony occurred and heart failure worsened. The indication for cardiac resynchronization was established. A biventricular ICD was successfully inserted with the left ventricular approach via the coronary sinus over the MONARCtrade mark device (Edward Lifescience, Irvine, CA, USA). Biventricular pacing significantly shortened the QRS duration and improved the clinical status as well as the 6-minute walking test.