Interventricular cardiac resynchronization with right ventricular apical pacing in a patient with Ebstein's defect.
We present the case of a patient with Ebstein's defect surgically corrected, and a complete right bundle branch block (RBBB) documented on echocardiogram. After an episode of near syncope due to a high-grade atrioventricular (AV) block, the patient was assisted with a bicameral DDDR pacemaker implanted with traditional right ventricular apical pacing. After the DDDR, and after stimulation with an AV delay of 180 ms, a narrow QRS complex was observed. Meanwhile, the typical left bundle branch block morphology of the right ventricular pacing and the native RBBB morphology were missing. The QRS complex narrowing persisted, even with physical activity and also with the heart rate progression. An echocardiographic study confirmed an improvement of the cardiac resynchronization parameters with this programmed stimulation.
Maffe
Stefano
S
Division of Cardiology, Borgomanero Hospital, Novara, Italy. stemaffe@libero.it
Perucca
Antonello
A
Paffoni
Paola
P
Signorotti
Fabiana
F
Pardo
Nicolò Franchetti
NF
Dellavesa
Pierfranco
P
Parravicini
Umberto
U
Zenone
Franco
F
Paino
Anna Maria
AM
Bielli
Massimo
M
Carola
Federico
F
Zanetta
Marco
M
D054537:Atrioventricular Block / Q000628:therapy; D002304:Cardiac Pacing, Artificial / Q000379:methods*; D004437:Ebstein Anomaly / Q000601:surgery / Q000628:therapy*; D004452:Echocardiography; D005260:Female; D006352:Heart Ventricles; D006801:Humans; D008875:Middle Aged