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Endocardial Transcatheter Stimulation of the AV Nodal Fat Pad: Stabilization of Rapid Ventricular Rate Response During Atrial Fibrillation in Left Ventricular Failure
Author(s) -
BIANCHI STEFANO,
ROSSI PIETRO,
SCALA ALBERTO DELLA,
KORNET LILIAN
Publication year - 2009
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.1540-8167.2008.01243.x
Subject(s) - medicine , cardiology , cardiogenic shock , atrial fibrillation , heart failure , atrioventricular node , hemodynamics , anesthesia , myocardial infarction , tachycardia
Recent acute studies demonstrated that atrioventricular (AV) node vagal stimulation during atrial fibrillation (AF) decreases the mean ventricular rate, thus improving hemodynamics. Methods and Results: We report a case of a woman with acute heart failure (HF), chronic AF with untreatable ventricular rapid response, in severe hypotensive state due to a cardiogenic shock. The patient underwent left ventricular (LV) pacemaker implantation and received 50 Hz AV node stimulation, delivered through a posteroseptal atrial lead, thus allowing a 100% pacing. Hemodynamics improvements allowed carvedilol titration; the rate was below 85 bpm after 4 days, then the atrial lead was removed. Conclusions: This novel strategy may allow controlling the rapid AV response in patients undergoing pacemaker implantation.