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Systolic left ventricular apical bulging after biventricular pacing mimicking takotsubo cardiomyopathy

Takayuki Nagai1, Hideki Okayama2, Katsuji Inoue1

  • 1Division of Cardiology, Department of Integrated Medicine and Informatics, Ehime University Graduate School of Medicine, Toon, Ehime, Japan.

Journal of Echocardiography
|June 10, 2016
PubMed

Insights

Nonresponsiveness to cardiac resynchronization therapy (CRT) can be overcome. A patient with heart failure and left bundle branch block had their CRT lead repositioned, restoring heart function and reversing remodeling.

Area of Science:

  • Cardiology
  • Medical Devices
  • Heart Failure Management

Background:

  • Nonresponsiveness to cardiac resynchronization therapy (CRT) is a significant challenge in managing heart failure patients with conduction disturbances.
  • Left bundle branch block (LBBB) is a common indication for CRT, but some patients do not respond adequately.

Purpose of the Study:

  • To describe a case of successful lead repositioning in a patient with refractory heart failure and LBBB who was initially nonresponsive to CRT.
  • To highlight the importance of optimal lead placement for CRT efficacy.

Main Methods:

  • Surgical implantation of an epicardial left ventricular (LV) lead guided by thoracoscopy.
  • Management of unexpected apical lead placement and subsequent lead re-implantation using an endovascular approach via a cardiac vein branch.
  • Echocardiographic assessment of left ventricular (LV) function and remodeling.

Main Results:

  • Initial LV lead placement on the apical side resulted in LV motion mimicking takotsubo cardiomyopathy and lack of CRT response.
  • Successful re-implantation of the LV lead into a lateral cardiac vein branch using an endovascular technique.
  • Restored LV contractility and reversal of LV remodeling post-lead repositioning.

Conclusions:

  • Optimal lead placement is critical for achieving successful cardiac resynchronization therapy.
  • Endovascular lead revision can be an effective strategy for managing CRT nonresponse due to lead malposition.
  • This case demonstrates a viable solution for refractory heart failure patients with LBBB and CRT lead issues.

Keywords:
Cardiac resynchronization therapyNon-responderSpeckle tracking echocardiographyTakotsubo cardiomyopathy

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