Key result
Multi-site left ventricular pacing via a biventricular defibrillator immediately suppressed refractory ventricular tachycardia and PVCs, improving LV function in a patient with narrow QRS.
Why the study?
Does multi-site left ventricular pacing reduce refractory ventricular tachycardia and PVC burden in a patient with non-ischemic cardiomyopathy and narrow complex QRS?
Case Report (n=1)
No
Does multi-site left ventricular pacing reduce refractory ventricular tachycardia and PVC burden in a patient with non-ischemic cardiomyopathy and narrow complex QRS?
Multi-site left ventricular pacing may serve as an effective alternative therapy for suppressing refractory ventricular tachycardia and improving LV function in patients with non-ischemic cardiomyopathy and narrow QRS who fail standard ablation and pharmacotherapy.
Hypothesis-generating for multi-site LV pacing in refractory VT with narrow QRS; prospective trials needed before clinical adoption.
A patient with non-ischemic cardiomyopathy, advanced heart failure, narrow complex QRS, >40% premature ventricular complexes (PVCs) and recurrent sustained monomorphic ventricular tachycardia (VT) episodes had failed pharmacotherapy and recurrent VT ablations. A trans-venous biventricular defibrillator with multi-site LV pacing (MS-CRTD) was implanted (i.e. two left ventricular (LV) leads through the coronary sinus and one right ventricular lead). Immediate reduction in PVCs burden was inspected. Within one year PVCS and VTs subsided, antiarrhythmic medications were discontinued, and LV function and heart failure symptoms improved dramatically. The case suggests that biventricular multi-site LV pacing may serve as an alternative option for treating refractory VT. Further studies to assess this technique and the underlying mechanism are warranted.
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A 2017 study conducted a case report in Refractory ventricular tachycardia and heart failure (n=1). Transvenous biventricular defibrillator with multi-site left ventricular pacing vs. Baseline was evaluated on Premature ventricular complexes (PVCs) burden and ventricular tachycardia (VT) episodes. Multi-site left ventricular pacing via a biventricular defibrillator immediately suppressed refractory ventricular tachycardia and PVCs, improving LV function in a patient with narrow QRS.
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