CRT39: TRIPLE-SITE BIVENTRICULAR STIMULATON IN PATIENT WITH CLINICALLY UNSUCCESSFUL RIGHT VENTRICULAR BIFOCAL STIMULATION–CASE REPORT

We report on a patient in whom we first implanted VVI bifocal (RVA+ RVOT) system and soon had to upgrade do biventricular (BiV) system since bifocal pacing turned to be hemodynamically insufficient. 63-yrs old male with postinfarction cardiomyopathy NYHA III, chronic atrial fibrillation, LBBB, LVEF 15%, assigned to BiV pacing was implanted with VVI pacemaker with RV bifocal stimulation because of LV lead implant failure (coronary sinus dissection, intraoperational dislodgement of lead from CS). Initially we observed certain improvement of symptoms during bifocal RV pacing, but after 3 months he returned with clinical worsening-NYHA III/IV despite optimal drug therapy, and signs of liver function impairment and BNP level 3290 fmol/l (N<250 fmol/l). Another attempt to place CS lead was successful and triple-site ventricular (TiV) pacing was applied. After3 months of follow-up significant clinical improvement is observed. Echocardiographic results are summarized in the table below View this table: Conclusion Right ventricular bifocal pacing considered as an alternative in the case of BiV system implantation failure in this case was not sufficient. Triple site biventricular stimulation provided additional benefit to BiV pacing.