title: Triangle ventricular pacing in a non-responder to conventional bi-ventricular pacing.
abstract: A 56-year-old man with cardiomyopathy secondary to myotonic dystrophy and complete atrioventricular block presented to our institution. A cardiac resynchronization therapy (CRT) device (InSync 8040, Medtronic, Inc., Minneapolis, MN, USA) was implanted by a conventional bi-ventricular pacing (Bi-V) technique. However, the patient's NYHA class did not improve from class IV despite optimized medical therapy. One month after the CRT device implantation, we altered the pacing configuration from that of Bi-V to 'triangle ventricular pacing' (Tri-V), i.e. conventional Bi-V from the right ventricular (RV) apex and left ventricle plus additional pacing from the RV outflow tract, using a Y connector to bifurcate the RV bipolar output of the device into an anode and a cathode. In both the acute and 3 month follow-up studies, objective parameters revealed better resynchronization effects with Tri-V, and the patient's NYHA class immediately improved to class II. Triangle ventricular pacing may have the potential to decrease the number of non-responders to CRT.
authors.affiliation: Cardiovascular Division, Institute of Clinical Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba 305-8575, Ibaraki, Japan. kentaroyo@nifty.com
authors.forename: Kentaro
authors.initials: K
authors.lastname: Yoshida
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Yokoyama
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Seo
authors.forename: Yukio
authors.initials: Y
authors.lastname: Sekiguchi
authors.forename: Kazutaka
authors.initials: K
authors.lastname: Aonuma
mesh_terms: D054537:Atrioventricular Block / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D002304:Cardiac Pacing, Artificial / Q000379:methods*; D009202:Cardiomyopathies / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D006352:Heart Ventricles / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial