Why the study?
Does right ventricular apical pacing with optimized AV delay improve cardiac resynchronization in a patient with surgically corrected Ebstein's defect and RBBB?
Does right ventricular apical pacing with optimized AV delay improve cardiac resynchronization in a patient with surgically corrected Ebstein's defect and RBBB?
Right ventricular apical pacing with optimized AV delay can achieve interventricular cardiac resynchronization in patients with surgically corrected Ebstein's anomaly and RBBB.
Suggests AV-optimized RV pacing may aid resynchronization in corrected Ebstein's with RBBB; hypothesis-generating and requires prospective validation.
We present the case of a patient with Ebstein's defect surgically corrected, and a complete right bundle branch block (RBBB) documented on echocardiogram. After an episode of near syncope due to a high-grade atrioventricular (AV) block, the patient was assisted with a bicameral DDDR pacemaker implanted with traditional right ventricular apical pacing. After the DDDR, and after stimulation with an AV delay of 180 ms, a narrow QRS complex was observed. Meanwhile, the typical left bundle branch block morphology of the right ventricular pacing and the native RBBB morphology were missing. The QRS complex narrowing persisted, even with physical activity and also with the heart rate progression. An echocardiographic study confirmed an improvement of the cardiac resynchronization parameters with this programmed stimulation.
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Maffè et al. (2008) studied this question.
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