Complex biventricular pacing - a case series.

Area of Science:

• Cardiology
• Electrophysiology
• Heart Failure Management

Background:

• Cardiac resynchronisation therapy (CRT) is proven effective for specific heart failure patients (NYHA class 3-4, EF ≤ 35%, QRS ≥ 120ms).
• Recent guideline updates broaden CRT eligibility criteria.
• Complex patient scenarios present challenges to conventional CRT implantation.

Purpose of the Study:

• To present two complex cases of cardiac resynchronisation therapy (CRT).
• To illustrate management strategies for challenging CRT indications.
• To highlight the adaptability of CRT in advanced heart failure management.

Main Methods:

• Case report 1: Management of CRT in a patient with occluded central veins.
• Case report 2: Application of CRT in a patient with a novel indication post-cardiac transplant.
• Review of current guidelines and literature for complex CRT cases.

Main Results:

• Successful CRT implantation and management were achieved in both complex cases.
• Case 1 demonstrated alternative venous access strategies for CRT lead placement.
• Case 2 highlighted the potential for CRT in select post-transplant recipients.

Conclusions:

• Complex CRT cases, including venous occlusions and novel indications like post-transplant, can be successfully managed.
• CRT's role in heart failure treatment is expanding beyond traditional indications.
• Careful patient selection and tailored implantation techniques are crucial for complex CRT cases.