Triple chamber pacemaker for end-stage heart failure in a patient with a previously implanted automatic defibrillator

A 63-year-old man with an ischemic dilated cardiomyopathy previously implanted with an implantable cardioverter defibrillator (ICD) received a triple chamber pacemaker as an ultimate therapeutic resort for end-stage congestive heart failure. After implant, the tolerance to physical exercise increased and NYHA class decreased from III to II. Echocardiography assessed ventricular contraction resynchronization during DDD biventricular pacing as compared to VVI pacing. No major pacemaker-ICD interaction was noted during testing or follow-up. We conclude that sequential biventricular pacing is feasible in the presence of an ICD.