Cardiac resynchronization therapy in a patient with Ebstein’s anomaly and left ventricular noncompaction: Rethink the resync?

Figures

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  Figure 1. A: The patient’s baseline electrocardiogram in sinus rhythm where the QRS shows a broad right bundle branch block with a slurred upstroke in leads 1 and aVL and a prolonged PR interval (suggesting concurrent conduction disease in the left bundle branch). The QRS duration was 180 ms. B: Cardiac computed tomography with severe right atrial dilatation, apical displacement of the septal and anterior leaflets of the tricuspid valve, and a very small right ventricle. Noncompacted myocardium is seen from the base to the apex on the free wall of the left ventricle. Ao = aorta; LV = left ventricle; RA = right atrium; TV = tricuspid valve.

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  Figure 2. A: Right anterior oblique view with the defibrillation lead in the right ventricular septum with the coil across the tricuspid annulus. The deflectable decapolar catheter is shown in the coronary sinus through the wide curve sheath traversing the severely dilated right atrium. B: Left anterior oblique view of the quadripolar left ventricular pacing lead positioned into a high lateral coronary sinus branch. C: Chest radiograph of the final lead positions in the heart. Severe right atrial enlargement can be appreciated with the significant prominence of the right heart border. D: Electrocardiogram following cardiac resynchronization therapy implant. Pacing is set up to fuse with the native QRS to obtain a width of 130 ms.