title: Successful bridge to resynchronization therapy with a left ventricular assist system in a patient with idiopathic dilated cardiomyopathy.
abstract: Implantation of a left ventricular assist system (LVAS) in patients with idiopathic dilated cardiomyopathy (DCM) may improve cardiac function and allow explantation of the device. Generally, an ejection fraction of more than 40% is considered necessary for successful weaning from an LVAS, but less than 10% of DCM patients with an LVAS can achieve such a significant recovery of cardiac function. Cardiac resynchronization therapy, or atrial-synchronized biventricular pacing, has been found to treat congestive heart failure and ventricular dyssynchrony effectively. Here we report on a patient with an LVAS, in whom enough functional recovery could be obtained with resynchronization therapy for the device to be explanted successfully. A 32-year-old man was implanted with a Toyobo-NCVC paracorporeal LVAS to treat his intractable heart failure caused by idiopathic dilated cardiomyopathy. While on the LVAS for 8 months, his cardiac function recovered to some extent. The ejection fraction of his left ventricle (LVEF) improved from 9% to 41%. He chose explantation of the device rather than heart transplantation. Because he occasionally showed a wide QRS pattern on his ECG, epicardial biventricular pacing leads as well as a biventricular pacemaker were implanted on LVAS explantation surgery. An echocardiogram 2 weeks after explantation showed a marked difference in his LVEF by switching his biventricular pacing on and off (40% with biventricular pacing on and 29% with it off). Biventricular pacing may help recovery of cardiac function in selected LVAS patients and contribute to the increase in bridge to recovery cases.
authors.affiliation: Department of Cardiovascular Surgery, Saitama Medical School, 38 Morohongo, Moroyama, Iruma, Saitama, 350-0495, Japan. nishimur@saitama-med.ac.jp
authors.forename: Motonobu
authors.initials: M
authors.lastname: Nishimura
authors.forename: Masanori
authors.initials: M
authors.lastname: Ogiwara
authors.forename: Masayuki
authors.initials: M
authors.lastname: Ishikawa
authors.forename: Kazuhito
authors.initials: K
authors.lastname: Imanaka
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Okamura
authors.forename: Masaaki
authors.initials: M
authors.lastname: Kato
authors.forename: Haruhiko
authors.initials: H
authors.lastname: Asano
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Katogi
authors.forename: Osami
authors.initials: O
authors.lastname: Kohmoto
authors.forename: Kazuo
authors.initials: K
authors.lastname: Matsumoto
authors.forename: Shigeyuki
authors.initials: S
authors.lastname: Nishimura
authors.forename: Shunei
authors.initials: S
authors.lastname: Kyo
mesh_terms: D000328:Adult; D002311:Cardiomyopathy, Dilated / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D020878:Device Removal; D004562:Electrocardiography; D006333:Heart Failure / Q000209:etiology / Q000628:therapy; D006353:Heart-Assist Devices; D006801:Humans; D008297:Male; D010138:Pacemaker, Artificial; D013318:Stroke Volume; D016277:Ventricular Function, Left