[Biventricular heart pacing and left ventricular heart pacing]

This report describes the case of a 60-year-old patient, affected by alcoholic hypokinetic dilated cardiomyopathy, drug refractory, without surgical indication for ischemic and valvular diseases, implanted with a biventricular pacemaker. The implant was followed by a rapid clinical improvement which allowed the patient's discharge in satisfactory conditions and with strongly reduced diuretic therapy. Ventricular pacing became only left due to increased right ventricular threshold. As a consequence a remarkable decrease in cardiocirculatory compensation was observed, with a new hospitalization due to worsening dyspnea and edema. The instrumental evaluation showed a worsening of the parameters linked to interventricular delay, particularly the interventricular septum activation delay and the reduction in its kinesis. An increase in the ventricular stimulation amplitude led again to a complete capture in both ventricles, with an improvement of interventricular synchronization parameters and septal kinesis. This fact turned into a rapid recovery of satisfactory cardiocirculatory compensation with subsequent patient's discharge.