title: Cardiac resynchronisation therapy in the presence of left-to-right intracardiac shunting: more good than harm?
abstract: An elderly Chinese man with moderately impaired left ventricular function, left bundle branch block and ST-elevation myocardial infarction complicated by ventricular septal rupture had class IV heart failure symptoms refractory to medical and surgical interventions. As a treatment of last resort, a cardiac resynchronisation therapy (CRT) pacemaker was implanted apprehensively, as preoperative concerns were raised whether CRT could exacerbate left-to-right shunting, hence negating the potential benefits of CRT. Introduction of CRT significantly improved the patient's haemodynamic status and symptoms, allowing for successful discharge home. To the best of our knowledge, this is the first report of a patient with severely symptomatic acute heart failure, widened QRS and active left-to-right intracardiac shunting, treated successfully with CRT.
authors.affiliation: National University Heart Centre, National University Hospital, Singapore, Singapore.
authors.forename: Kyu
authors.initials: K
authors.lastname: Kyu
authors.affiliation: National University Heart Centre, National University Hospital, Singapore, Singapore.
authors.forename: Swee Chong
authors.initials: SC
authors.lastname: Seow
authors.affiliation: National University Heart Centre, National University Hospital, Singapore, Singapore.
authors.forename: Raymond
authors.initials: R
authors.lastname: Wong
authors.affiliation: National University Heart Centre, National University Hospital, Singapore, Singapore.
authors.forename: Pipin
authors.initials: P
authors.lastname: Kojodjojo
mesh_terms: D000368:Aged; D002037:Bundle-Branch Block / Q000150:complications / Q000628:therapy*; D058406:Cardiac Resynchronization Therapy; D006333:Heart Failure / Q000175:diagnosis* / Q000209:etiology; D006801:Humans; D008297:Male; D011654:Pulmonary Edema / Q000209:etiology; D018487:Ventricular Dysfunction, Left / Q000209:etiology; D018658:Ventricular Septal Rupture / Q000175:diagnosis*