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Europace 2005 7(4):380-384; doi:10.1016/j.eupc.2005.01.008
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© 2005 The European Society of Cardiology. Published by Elsevier Ltd. All rights reserved.

CASE REPORT

Cardiac resynchronisation therapy versus dual site right ventricular pacing in a patient with permanent pacemaker and congestive heart failure

Oruganti Sai Satisha, Kuan-Hung Yehb, Ming-Shien Wenb and Chun-Chieh Wangb,*

aNizam's Institute of Medical Sciences Hyderabad, India; bDepartment of Medicine, Second Section of Cardiology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine 199 Tung Hwa North Road, Sung-Shan District, Tao-Yuan, Taipei 111, Taiwan

A 46-year-old male patient who had long-term right ventricular (RV) pacing for symptomatic complete heart block, initially by an epicardial, later with an endocardial pacing lead at the RV apex, developed congestive heart failure (CHF) and chronic atrial fibrillation 7 years following the pacemaker implantation and was medically treated. During follow-up, his pacemaker was upgraded to a cardiac resynchronisation therapy (CRT) device, because of uncontrolled CHF symptoms, New York Heart Association (NYHA) functional class IV, while on drugs. The patient's symptomatic status improved to NYHA functional class II with CRT. After 17 months of CRT, the battery became depleted, because of the high capture threshold of the left ventricular lead. The patient was then given dual site RV pacing (RV outflow tract + RV apex) in place of CRT, which showed similar efficacy at 12 weeks follow-up.

Key Words: cardiac resynchronisation therapy, heart failure, complete heart block, pacemaker, atrial fibrillation

*Corresponding author. Tel.: +886 3 3281200; fax: +886 3 3289134. E-mail address: chcwang{at}adm.cgmh.org.tw (C.-C. Wang).


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