title: Dramatic Response to Cardiac Resynchronization Therapy With AV Delay Optimization in Narrow QRS Heart Failure.
abstract: Cardiac resynchronization therapy (CRT) has been shown to be effective for heart failure. However, as outlined in the AHA/ACC/HRS Appropriate Use Criteria, CRT is not strongly recommended for patients with a narrow QRS complex. We describe a case of dilated cardiomyopathy and narrow QRS complex in which we obtained a dramatic response to CRT by optimizing the atrioventricular (AV) delay. The patient was a 61-year-old man with intractable heart failure. Echocardiography showed a low ejection fraction of 22% but no dyssynchrony. Because he had been hospitalized many times for congestive heart failure despite β-blocker and diuretic treatment, we decided to use CRT. However, after implantation of the CRT device, the QRS complex widened abnormally, and his symptoms worsened. He was re-admitted 2 months after CRT implantation. We examined the pacemaker status and optimized the AV delay to obtain a "narrow" QRS complex. The patient's condition improved dramatically after the AV delay optimization. His clinical status has been good, and there has been no subsequent hospitalization. Our case points to the effectiveness of CRT in patients with a narrow QRS complex and to the importance of AV optimization for successful CRT.
authors.affiliation: Division of Cardiology, Department of Medicine, Nihon University School of Medicine.
authors.forename: Rikitake
authors.initials: R
authors.lastname: Kogawa
authors.forename: Toshiko
authors.initials: T
authors.lastname: Nakai
authors.forename: Yukitoshi
authors.initials: Y
authors.lastname: Ikeya
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Mano
authors.forename: Kazumasa
authors.initials: K
authors.lastname: Sonoda
authors.forename: Naoko
authors.initials: N
authors.lastname: Sasaki
authors.forename: Kazuki
authors.initials: K
authors.lastname: Iso
authors.forename: Yasuo
authors.initials: Y
authors.lastname: Okumura
authors.forename: Kimie
authors.initials: K
authors.lastname: Ohkubo
authors.forename: Satoshi
authors.initials: S
authors.lastname: Kunimoto
authors.forename: Ichiro
authors.initials: I
authors.lastname: Watanabe
authors.forename: Atsushi
authors.initials: A
authors.lastname: Hirayama
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D058406:Cardiac Resynchronization Therapy / Q000379:methods*; D002311:Cardiomyopathy, Dilated / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D018450:Disease Progression; D004232:Diuretics / Q000627:therapeutic use*; D004351:Drug Resistance; D004562:Electrocardiography / Q000379:methods; D006333:Heart Failure / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome
chemical_list: D000319:Adrenergic beta-Antagonists; D004232:Diuretics