Biventricular Pacing Using Two Pacemakers and Triggered VVT Mode in Patients With Atrial Fibrillation and Congestive Heart Failure: A Case Report

Transcription

1 2 VVT 1 Biventricular Pacing Using Two Pacemakers and Triggered VVT Mode in Patients With Atrial Fibrillation and Congestive Heart Failure: A Case Report Youhei Toshiyuki Kazuaki Shinichi Yasuyuki Toshiaki Shunichi Tsukasa Kohei Yasuo Yutaka Yutaka Satoshi YAMAKAWA, MD ISHIKAWA, MD, FJCC UCHINO, MD SUMITA, MD MOCHIDA, MD EBINA, MD KOBAYASHI, MD KOBAYASHI, MD MATSUSHITA, MD OKUSU, MD TANAKA, MD KITAMURA, MD UMEMURA, MD Abstract A 76-year-old female had undergone implantation of a single chamber pacemaker for sick sinus syndrome 20 years previously. She developed chronic atrial fibrillation and required repeated admission due to congestive heart failure. She had significant mitral and tricuspid regurgitation. Paradoxical movement of the intraventricular septum was severe. Due to right ventricular apical pacing, significant interventricular conduction delay was present with a paced QRS duration of 189msec. The left ventricular pacing lead was positioned via the coronary sinus. The mode of the previously implanted pacemaker was set at VVT. Biventricular pacing could be achieved even in intrinsic beats by VVT mode. The battery life time was improved. This method is useful in patients with conventional pacemakers. J Cardiol 2002 Apr; 39 4 : Key Words Heart failure, treatment Atrial fibrillation Pacing biventricular, VVT mode car- diac resynchronization therapy 1 7 : ; The Second Department of Internal Medicine, Yokohama City University School of Medicine, Yokohama ; Department of Cardiology, Yokosuka City Hospital, Kanagawa Address for correspondence : ISHIKAWA T, MD, FJCC, The Second Department of Internal Medicine, Yokohama City University School of Medicine, Fukuura 3 9, Kanazawa-ku, Yokohama Manuscript received November 20, 2001 ; revised January 7, 2002; accepted January 7,

2 VVT Fig. 1 Chest radiograph posteroanterior view before biventricular pacing 76 : : : : :56 VVI 2 New York Heart Association NYHA X : 85% Fig. 1 : 70 beats/min QRS 189 msec, QRS 120 msec : / K Fig. 2 VVT VVT QRS 189 msec 243 msec 161 msec PiCCO PULSION Medical Systems 3.21l/min3.23l/min 3.32 l/min Fig. 3 Fig cm/sec 231cm/sec pg/ml 1, pg/ml J Cardiol 2002 Apr; 39 4 :

3 223 Fig. 2 Chest radiographs left: posteroanterior view, right: lateral view after biventricular pacing Pacing leads are positioned in the right ventricular apex arrowhead and the left ventricular free wall arrow via the coronary sinus. Fig. 3 Electrocardiograms during non pacing, right ventricular RV pacing, left ventricular LV pacing, and biventricular pacing CO cardiac output.

4 224 Fig. 4 Transthoracic M-mode echocardiograms in the long-axis view from the parasternal approach Paradoxical movement of the intraventricular septum is severe during right ventricular pacing upper. Paradoxical movement is mildly improved by biventricular pacing lower pg/mlNa 55 39pg/ml Na pg/ml NYHA dp/dt 1 2,3 dysynchrony 4 5 NYHA VVI QRS 189 msec QRS 120 msec QRS Y J Cardiol 2002 Apr; 39 4 :

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