E-ISSN 2534-9821
 

Case Report 


Cardiac resynchronization therapy with physiological left bundle branch pacing as a treatment for arrhythmogenic cardiomyopathy with left ventricle involvement: a new therapeutic approach?

Albina Aldomà-Balasch, Isabel Hernández-Martín.

Abstract
BACKGROUND: Arrhythmogenic cardiomyopathy (ACM) is inherited cardiomyopathy with an autosomal pattern of inheritance, incomplete penetrance and variable expressivity, which generally presents in young adults. Given the progressive nature of the disease, there are no specific therapeutic options other than medical treatment for heart failure (HF) with reduced ejection fraction (HFrEF), and antiarrhythmic management with antiarrhythmic drugs and implantable cardioverter-defibrillator (ICD) implantation.

CASE SUMMARY: We report the case of a female patient who made her debut with ACM with ventricular arrhythmias at the age of 74. The cardiac magnetic resonance showed biventricular involvement, predominantly right ventricle (RV). A cardiac resynchronization therapy (CRT)-ICD implantation was performed with sensing/stimulation electrode positioned in the left bundle branch of the His (LBBH), and defibrillation function with a high-voltage bovine electrode implanted in the posterior interventricular vein of the coronary sinus, due to the presence of a thrombus within the apical RV aneurysm that did not resolve despite anticoagulation. Eight months after implantation, left ventricular (LV) ejection fraction (EF) improved slightly, from 34% at baseline to 42%, and the patient did not present arrhythmias or HF symptoms.

DISCUSSION: Our patient presented the first clinical manifestation of ACM at a much older age than usual for this disease, as most patients are diagnosed before the age of 50. CRT-ICD implantation with physiologic pacing of the LBBH could represent a new therapeutic approach in case of LV involvement with reduced EF, in addition to the novel drugs for HFrEF, all of which might contribute to improving the prognosis of these patients.

Key words: Arrhythmogenic cardiomyopathy, Cardiac resynchronization therapy, Physiologic pacing of the left bundle branch, Case report


 
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Pubmed Style

Aldomà-Balasch A, Hernández-Martín I. Cardiac resynchronization therapy with physiological left bundle branch pacing as a treatment for arrhythmogenic cardiomyopathy with left ventricle involvement: a new therapeutic approach?. Int J Med Rev Case Rep. 2022; 6(2): 96-100. doi:10.5455/IJMRCR.Cardiacresynchronizationtherapywithphysiologicalleftbundlebranchpacing


Web Style

Aldomà-Balasch A, Hernández-Martín I. Cardiac resynchronization therapy with physiological left bundle branch pacing as a treatment for arrhythmogenic cardiomyopathy with left ventricle involvement: a new therapeutic approach?. https://www.mdpub.net/?mno=130120 [Access: November 19, 2022]. doi:10.5455/IJMRCR.Cardiacresynchronizationtherapywithphysiologicalleftbundlebranchpacing


AMA (American Medical Association) Style

Aldomà-Balasch A, Hernández-Martín I. Cardiac resynchronization therapy with physiological left bundle branch pacing as a treatment for arrhythmogenic cardiomyopathy with left ventricle involvement: a new therapeutic approach?. Int J Med Rev Case Rep. 2022; 6(2): 96-100. doi:10.5455/IJMRCR.Cardiacresynchronizationtherapywithphysiologicalleftbundlebranchpacing



Vancouver/ICMJE Style

Aldomà-Balasch A, Hernández-Martín I. Cardiac resynchronization therapy with physiological left bundle branch pacing as a treatment for arrhythmogenic cardiomyopathy with left ventricle involvement: a new therapeutic approach?. Int J Med Rev Case Rep. (2022), [cited November 19, 2022]; 6(2): 96-100. doi:10.5455/IJMRCR.Cardiacresynchronizationtherapywithphysiologicalleftbundlebranchpacing



Harvard Style

Aldomà-Balasch, A. & Hernández-Martín, . I. (2022) Cardiac resynchronization therapy with physiological left bundle branch pacing as a treatment for arrhythmogenic cardiomyopathy with left ventricle involvement: a new therapeutic approach?. Int J Med Rev Case Rep, 6 (2), 96-100. doi:10.5455/IJMRCR.Cardiacresynchronizationtherapywithphysiologicalleftbundlebranchpacing



Turabian Style

Aldomà-Balasch, Albina, and Isabel Hernández-Martín. 2022. Cardiac resynchronization therapy with physiological left bundle branch pacing as a treatment for arrhythmogenic cardiomyopathy with left ventricle involvement: a new therapeutic approach?. International Journal of Medical Reviews and Case Reports, 6 (2), 96-100. doi:10.5455/IJMRCR.Cardiacresynchronizationtherapywithphysiologicalleftbundlebranchpacing



Chicago Style

Aldomà-Balasch, Albina, and Isabel Hernández-Martín. "Cardiac resynchronization therapy with physiological left bundle branch pacing as a treatment for arrhythmogenic cardiomyopathy with left ventricle involvement: a new therapeutic approach?." International Journal of Medical Reviews and Case Reports 6 (2022), 96-100. doi:10.5455/IJMRCR.Cardiacresynchronizationtherapywithphysiologicalleftbundlebranchpacing



MLA (The Modern Language Association) Style

Aldomà-Balasch, Albina, and Isabel Hernández-Martín. "Cardiac resynchronization therapy with physiological left bundle branch pacing as a treatment for arrhythmogenic cardiomyopathy with left ventricle involvement: a new therapeutic approach?." International Journal of Medical Reviews and Case Reports 6.2 (2022), 96-100. Print. doi:10.5455/IJMRCR.Cardiacresynchronizationtherapywithphysiologicalleftbundlebranchpacing



APA (American Psychological Association) Style

Aldomà-Balasch, A. & Hernández-Martín, . I. (2022) Cardiac resynchronization therapy with physiological left bundle branch pacing as a treatment for arrhythmogenic cardiomyopathy with left ventricle involvement: a new therapeutic approach?. International Journal of Medical Reviews and Case Reports, 6 (2), 96-100. doi:10.5455/IJMRCR.Cardiacresynchronizationtherapywithphysiologicalleftbundlebranchpacing