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Postero‐Lateral Scar Tissue Resulting in Non‐Response to Cardiac Resynchronization Therapy
Author(s) -
BLEEKER GABE B.,
SCHALIJ MARTIN J.,
VAN DER WALL ERNST E.,
BAX JEROEN J.
Publication year - 2006
Publication title -
journal of cardiovascular electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.193
H-Index - 138
eISSN - 1540-8167
pISSN - 1045-3873
DOI - 10.1111/j.1540-8167.2006.00499.x
Subject(s) - medicine , cardiac resynchronization therapy , cardiology , heart failure , doppler imaging , ventricular dyssynchrony , ischemic cardiomyopathy , myocardial infarction , cardiomyopathy , scar tissue , surgery , ejection fraction , diastole , blood pressure
In large cardiac resynchronization therapy (CRT) trials, approximately 20–30% of patients did not respond to CRT. Recent studies indicated that left ventricular (LV) dyssynchrony is needed for response to CRT. However, the presence of LV dyssynchrony may not be the only determinant of response, because some patients with LV dyssynchrony do not benefit from CRT. In the current case report, we present a patient with ischemic cardiomyopathy, NYHA class III heart failure symptoms, and substantial LV dyssynchrony on tissue Doppler imaging who underwent CRT implantation but did not respond. Following CRT, LV dyssynchrony was not reduced and the patient did not improve in clinical symptoms or LV function. The lack of LV resynchronization was explained by the presence of extensive scar tissue in the region of the tip of the LV pacing lead resulting in ineffective LV pacing. In patients with ischemic cardiomyopathy and history of previous infarction, assessment of scar tissue should be considered before CRT implantation.