title: [Biventricular pacing dramatically improved critical heart failure in idiopathic dilated cardiomyopathy: two case reports].
abstract: Two cases of dilated cardiomyopathy with intraventricular conduction delay, or left bundle-branch block and refractory heart failure, were markedly improved by biventricular pacing. The first patient's condition (Case 1) could not be improved despite administration of intravenous inotropic agents. He required mechanical ventilation and continuous hemodialysis as his condition worsened. Biventricular pacing was performed which was soon followed by increased blood pressure and decreased mitral regurgitation. As a result, mechanical ventilation, continuous hemodialysis and intravenous medication could be withdrawn. The second patient's condition (Case 2) deteriorated because of bradycardia due to advanced atrioventricular block. Unexpectedly, temporary right atrium-right ventricle sequential pacing increased mitral regurgitation and then caused heart failure, requiring a higher dose of inotropic and diuretic agents. Therefore, biventricular pacing was performed which rapidly improved both his symptoms and hemodynamic state, allowing reduction of the medication dose. Biventricular pacing dramatically improves critical conditions in patients in life-threatening states.
authors.affiliation: Department of Cardiology, Osaka City General Hospital, Miyakojima-hondori 2-13-22, Miyakojima-ku, Osaka 534-0021.
authors.forename: Kenji
authors.initials: K
authors.lastname: Shimeno
authors.forename: Masato
authors.initials: M
authors.lastname: Otsuka
authors.forename: Michitaka
authors.initials: M
authors.lastname: Nagashima
authors.forename: Kinya
authors.initials: K
authors.lastname: Ashida
authors.forename: Yukio
authors.initials: Y
authors.lastname: Abe
authors.forename: Ryushi
authors.initials: R
authors.lastname: Komatsu
authors.forename: Yuji
authors.initials: Y
authors.lastname: Sakanoue
authors.forename: Takahiko
authors.initials: T
authors.lastname: Naruko
authors.forename: Akira
authors.initials: A
authors.lastname: Itoh
authors.forename: Morio
authors.initials: M
authors.lastname: Shoda
authors.forename: Kazuo
authors.initials: K
authors.lastname: Haze
mesh_terms: D000368:Aged; D002037:Bundle-Branch Block / Q000628:therapy; D002304:Cardiac Pacing, Artificial; D002311:Cardiomyopathy, Dilated / Q000150:complications*; D006333:Heart Failure / Q000628:therapy*; D006352:Heart Ventricles; D006801:Humans; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000628:therapy; D012121:Respiration, Artificial