Bilateral Venous Access for Cardiac Resynchronization Therapy in a Hemodialysis Patient With Cabozantinib-associated...

Cabozantinib, a multi-targeted tyrosine kinase inhibitor, is widely used for the treatment of renal and hepatic cancers. While cabozantinib-associated cardiotoxicity is rare, it has been documented in several cases. In most instances, cancer therapeutics-related cardiac dysfunction (CTRCD) is managed by discontinuing cabozantinib and initiating cardioprotective agents. In this report, we present the case of a 63-year-old male with cabozantinib-induced heart failure (HF) with reduced ejection fraction (EF) and complete left bundle branch block (CLBBB).

The patient, undergoing hemodialysis for chronic kidney disease, had limited therapeutic options due to prior treatment failures. Despite six months of standard HF therapy, symptoms persisted, prompting cardiac resynchronization therapy (CRT) implantation without interrupting cabozantinib. Due to the presence of a dialysis shunt in the patient's left arm, the right subclavian vein was selected for venous access to minimize the risk of lead-related complications. Using a tunneling tool, the left ventricular lead was placed via the contralateral vasculature to the ipsilateral generator. Six months post-CRT, echocardiography showed significant reverse remodeling with improved EF and reduced left ventricular end-diastolic diameter, alongside clinical symptom relief.

This case highlights the utility of bilateral venous access with a tunneling tool in cardiac resynchronization therapy, particularly for patients with hemodialysis shunts.