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Biventricular pacing using dual-site right ventricular stimulation: is it placebo effect?
1Stony Brook Arrhythmia Study and Sudden Death Prevention Center and the Echocardiography Laboratory, Cardiology Division, Department of Medicine, Stony Brook University, Stony Brook, New York, USA. svlay@notes.cc.sunysb.edu
Pacing and Clinical Electrophysiology : PACE
|August 4, 2006
Summary
Alternate lead placement in cardiac resynchronization therapy (CRT) using the right ventricular outflow tract (RVOT) showed promise. Repositioning an RVOT lead due to Twiddler's syndrome improved patient outcomes, suggesting a viable CRT alternative.
Area of Science:
- Cardiology
- Medical Devices
- Heart Failure Management
Background:
- Cardiac resynchronization therapy (CRT) is crucial for heart failure management.
- Coronary sinus lead placement is standard but not always feasible.
- Alternate lead sites require further validation.
Observation:
- A patient with heart failure, unsuitable for standard CRT lead placement, received a lead in the right ventricular outflow tract (RVOT).
- Initial RVOT lead placement led to clinical improvement.
- Lead dislodgement (Twiddler's syndrome) caused recurrence of heart failure symptoms.
Findings:
- Repositioning the RVOT lead successfully restored clinical improvement and hemodynamic function.
- Dual-site right ventricular (RV) pacing did not result in measurable intraventricular dyssynchrony via echocardiography.
- Tissue Doppler imaging correlated with clinical improvement during dual-site RV pacing.
Implications:
- Right ventricular outflow tract (RVOT) lead placement may be a viable alternative for CRT when standard methods fail.
- Dual-site RV pacing shows potential for CRT, evidenced by clinical and echocardiographic improvements.
- This case highlights the importance of lead stability and offers insights into alternative CRT strategies.
