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RESEARCH PRODUCT

Role of CRT upgrading in pacing induced heart failure: A case report

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Abstract We submit a case report of a 78-year-old male came to our department for systolic heart, failure (EF of 25%). He has clinical history of recurring atrial tachycardia and atrial flutter previously treated in our department unsuccessfully with antiarrhythmic drug therapy. The echocardiographic evidence of left atrial enlargement (left atrium area 40 cm 2 ) and the clinical history of permanent atrial tachycardia has discouraged any attempt of substrate ablation. As it is impossible get rhythm and rate control with drug therapy, the patient was subjected to an "ablate and pace" procedure with implantation of a VVIR mode pacemaker. Also, for the absence of indications (QRS width During this last hospital stay, after pharmacological treatment with intravenous furosemide and ACE inhibitor, on the basis of last electrocardiographic and echocardiographic data, was therefore carried out an upgrading of the pacemaker to CRT-P with significant improvement in symptoms and systolic function (EF55%) just six months after upgrading. This case report shows that in pacemaker dependent patients, with interventricular mechanical delay, the right ventricular apical pacing may results in intolerable adverse effects. For these reasons, in this kind of patients the implantation of a CRT device may be considered as initial measure. It is hoped that future international guidelines can support this indication.