title: Biventricular pacing using dual-site right ventricular stimulation: is it placebo effect?
abstract: Alternate site lead placement in cardiac resynchronization therapy has been used successfully but remains to be validated. A 62-year-old heart failure patient in whom coronary sinus lead placement was not possible underwent implantation of the lead in the right ventricular outflow tract (RVOT) and demonstrated clinical improvement as measured by New York Heart Association class and noninvasive parameters. When heart failure recurred, it was determined that his RVOT electrode had been pulled back (Twiddler's syndrome). Repositioning again improved his clinical status and noninvasive hemodynamic measurements. With dual-site right ventricular (RV) pacing there was no echocardiographic measurable intraventricular dyssynchrony. Tissue Doppler imaging correlated with clinical improvement using dual-site RV pacing, providing evidence that this technique may represent a viable alternative in cardiac resynchronization therapy.
authors.affiliation: Stony Brook Arrhythmia Study and Sudden Death Prevention Center and the Echocardiography Laboratory, Cardiology Division, Department of Medicine, Stony Brook University, Stony Brook, New York, USA. svlay@notes.cc.sunysb.edu
authors.forename: Stephen C
authors.initials: SC
authors.lastname: Vlay
authors.forename: Smadar
authors.initials: S
authors.lastname: Kort
mesh_terms: D002304:Cardiac Pacing, Artificial / Q000379:methods*; D015150:Echocardiography, Doppler; D004562:Electrocardiography; D006333:Heart Failure / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015990:Placebo Effect; D012008:Recurrence