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A 58-year-old woman with chronic heart failure (CHF) received cardiac resynchronization-defibrillator (CRT-D) therapy without atrial lead implantation due to longstanding atrial fibrillation (AF). Three months after oral amiodarone therapy was initiated for the treatment of non-sustained ventricular tachycardia detected by the CRT-D device, the patient's heart failure symptoms worsened and 12-lead electrocardiography showed newly emerged p-waves with atrioventricular (AV) dissociation. Immediately after the device was upgraded to the DDD-biventricular pacemaker, the patient's heart failure symptoms and cardiac function dramatically improved, which suggests that AV dissociation has a much more negative impact on the cardiac function than AF in patients with CHF.

internal medicine

Heart Failure Exacerbation Associated with Newly Developed Atrioventricular Dyssynchrony after Chemical Conversion to a Sinus Rhythm in a Patient Receiving Cardiac Resynchronization Therapy