Journal Article

CP23: CRT IN RIGHT VENTRICULE FOR A SENNING PATIENT: A CASE REPORT

Ga¨l JAUVERT, Elisabeth VILLAIN, Laurence ISERIN, Nicolas BONNET, Franôoise HIDDEN-LUCET, Robert FRANK and Daniel SIDI

in EP Europace

Published on behalf of European Heart Rhythm Association of the European Society of Cardiology (ESC)

Volume 7, issue 3, pages 292-292
Published in print May 2005 | ISSN: 1099-5129
Published online May 2005 | e-ISSN: 1532-2092 | DOI: https://dx.doi.org/10.1016/j.eupc.2005.02.020
CP23: CRT IN RIGHT VENTRICULE FOR A SENNING PATIENT: A CASE REPORT

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This case report highlights the feasibility of CRT in sub-aortic right ventricle dysynchrony, induced by left ventricular pacing, in patients with atrial switch operation fro transposition of great arteries.

Medical history

This 32 years old patient, had a Senning operation (atrial switch) in childhood. Subsequent complete AV block required endocardial DDD pacing. Due to failing sub-aortic right ventricle, the patient developed progressive Heart failure, despite appropriate medical treatment. Systemic right ventricle dysynchrony was evaluated, before registering this patient on heart transplant program.

Baseline data

Functional status: NYHA class III

Inter-ventricular, intra-ventricular and AV dysynchrony assessed by echo:

LPEI RPEI IVD QRS-Ew LV DFT LSD QRS-LLW QRS-LSW 185 ms 135 ms 50 ms 545 ms 325 ms 460 ms 405 ms 525 ms

Intra-ventricular asynchrony results from inter-ventricular septum delayed contraction.

Intervention

Based on these data, a new LV lead was implanted on the inter-ventricular septum. An epicardial lead was positioned on the lateral free wall of the sub-aortic RV. Leads were connected to a triple chamber PM.

Post op results

NYHA class I/II, increased Bblockers and reduced diuretics at 1 month. Correction of the dysynchrony assessed by echo:

LPEI RPEI IVD QRS-Ew LV DFT LSD QRS-LLW QRS-LSW 110 ms 110 ms 0 ms 560 ms 430 ms 450 ms 420 ms 430 ms

Evolution

clinical and electromechanical stability at 3 months.

Conclusion

CRT is feasible and may improve patients with a sub-aortic right ventricle after Senning operation for transposition of great arteries. In these patients, left ventricular pacing may induce or reveal electro-mechanical dysynchrony. Septal pacing site might be preferable to apical site, as inter-ventricular septum proper motion is certainly hemodynamically crucial in these patients.

Journal Article.  0 words. 

Subjects: Cardiovascular Medicine

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