Miśkowiec Dawid, Życiński Paweł, Qawoq Dariusz H, Pagórek Piotr, Zając Piotr, Chudzik Michał, Wcisło Tomasz, Kasprzak Jarosław D
Department of Cardiology, Medical University of Lodz, Lodz, Poland.
Ann Noninvasive Electrocardiol. 2019 Sep;24(5):e12666. doi: 10.1111/anec.12666. Epub 2019 Jun 26.
A 53-year-old male with heart failure secondary to anterior wall myocardial infarction treated with cardiac resynchronization-defibrillator (CRT-D) device presented with ventricular arrhythmia: repetitive incessant slow ventricular tachycardias (VT) below the CRT-D detection zone, accelerated ventricular rhythm, and numerous premature ventricular ectopic beats (ExV), resulting in loss of biventricular pacing.
Nonsustained monomorphic VT (nsVT) and ExV were observed in an electrocardiogram under biventricular stimulation. During noninvasive CRT-D programming, ventricular bigeminy reproducibly recurred only at right ventricular (RV) pacing and its morphology was almost identical to the stimulated beats. The left ventricular (LV) pacing failed to induce ventricular ectopy or tachycardia.
This unusual case shows a rare phenomenon of late proarrhythmic effect due to the RV lead pacing-a new finding reported only in a few publications. Here we present our approach to CRT programming that suppressed the clinical arrhythmia without the need of catheter ablation and achieving the high biventricular pacing capture rate along with optimal hemodynamic CRT-D performance.
一名53岁男性，因前壁心肌梗死继发心力衰竭，接受心脏再同步除颤器（CRT-D）治疗，出现室性心律失常：CRT-D检测区以下反复不停的缓慢室性心动过速（VT）、加速性室性心律以及大量室性早搏（ExV），导致双心室起搏丧失。
在双心室刺激下的心电图中观察到非持续性单形性室速（nsVT）和ExV。在无创CRT-D程控期间，室性二联律仅在右心室（RV）起搏时反复出现，其形态与刺激后的搏动几乎相同。左心室（LV）起搏未能诱发室性异位搏动或心动过速。
该罕见病例显示了右心室导线起搏引起的迟发性促心律失常效应这一罕见现象——仅有少数出版物报道过这一新发现。在此，我们展示了我们的CRT程控方法，该方法无需导管消融即可抑制临床心律失常，并实现高双心室起搏捕获率以及最佳的血流动力学CRT-D性能。
