Cardiac Resynchronization Therapy and Proarrhythmia: Weathering the Storm

Authors

  • Apostolos - Ilias Vouliotis 1st Department of Cardiology, Athens University Medical School.
  • Dimitrios Tsiachris 1st Department of Cardiology, Athens University Medical School.
  • Polychronis Dilaveris 1st Department of Cardiology, Athens University Medical School.
  • Skevos Sideris State Department of Cardiology, Hippokration General Hospital of Athens.
  • Konstantinos A Gatzoulis 1st Department of Cardiology, Athens University Medical School.

DOI:

https://doi.org/10.2015/hc.v7i4.457

Keywords:

Biventricular pacing, Cardiac resynchronization therapy, Ventricular tachycardia storm, Proarrhythmia

Abstract

In patients with significant left ventricular (LV) dysfunction and congestive heart failure despite optimal medical therapy, implantation of cardiac resynchronization therapy-defibrillator (CRT-D) devices has been shown to improve symptoms and diminish ventricular tachyarrhythmia susceptibility.

We describe the case of a patient with dilated cardiomyopathy who developed ventricular tachycardia storm (VTS) one month after the implantation of a CRT-D device. VTS was initially controlled with pharmacotherapy, allowing the patient to continue with biventricular pacing. Two months later the patient was readmitted due to multiple episodes of polymorphic ventricular tachycardia. VTS was refractory to various intravenous antiarrhythmic drugs and it was finally controlled only when LV pacing was turned off.

In patients with heart failure treated with CRT-D, VTS can occur and is best managed by turning off LV pacing. Our report raises an important and concerning issue of biventricular pacing causing ‘proarrhythmia’ in rare instances.

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Published

2012-08-24

Issue

Section

CASE REPORTS