Ventricular resynchronization by implementation of direct his bundle pacing in a patient with congenital complete AV block and newly diagnosed cardiomyopathy.
Congenital complete atrioventricular block (CCAVB) is usually due to failure of AV nodal conduction with preservation of the His Purkinje system, typically present at birth. While most patients with CCAVB ultimately require pacemaker therapy to restore physiologic heart rates, recent studies have suggested that chronic right ventricular (RV) pacing in patients with CCAVB can have detrimental effects on cardiac structure and function, and may account for a 7-10% incidence of congestive heart failure in these patients. Since the His Purkinje system is preserved in CCAVB, this patient population could be uniquely well served by direct His bundle pacing (DHBP) which would be expected to restore physiologic activation of both ventricles. We present a case of a young woman who presented with RV pacing-induced cardiomyopathy who responded dramatically to DHBP.
Department of Medicine, University of Vermont School of Medicine and Fletcher Allen Health Care, Burlington, Vermont, USA.
Alia E
AE
Rehwinkel
Joachim G
JG
Müller
Peter C
PC
Vanburen
Daniel L
DL
Lustgarten
D000328:Adult; D054537:Atrioventricular Block / Q000175:diagnosis / Q000503:physiopathology* / Q000628:therapy; D002036:Bundle of His / Q000502:physiology*; D058406:Cardiac Resynchronization Therapy / Q000379:methods*; D009202:Cardiomyopathies / Q000175:diagnosis / Q000503:physiopathology* / Q000628:therapy; D005260:Female; D006327:Heart Block / Q000151:congenital* / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy; D006801:Humans; D016278:Ventricular Function, Right / Q000502:physiology*