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(Circulation. 2006;114:2685-2691.)
© 2006 American Heart Association, Inc.

Controversies in Cardiovascular Medicine

Should all patients with heart failure and intraventricular conduction defect or dyssynchrony receive cardiac resynchronization therapy?

All Patients With Heart Failure and Intraventricular Conduction Defect or Dyssynchrony Should Not Receive Cardiac Resynchronization Therapy

Barry Greenberg, MD; Mandeep R. Mehra, MD

From the University of California, San Diego, San Diego, Calif (B.G.), and University of Maryland, Baltimore (M.R.M.).

Correspondence to Barry Greenberg, MD, Professor of Medicine, Director, Heart Failure/Cardiac Transplantation Program, University of California, San Diego, 200 W Arbor St, San Diego, CA 92103–8411. E-mail bgreenberg@ucsd.edu

An extract of the first 250 words of the full text is provided, because this article has no abstract.

	Introduction

 
Case Presentation: J.S., a 72-year-old man, was diagnosed with heart failure 5 years ago. Before that, he had suffered a large anterior myocardial infarction and had undergone successful coronary artery bypass grafting surgery. An internal cardioverter-defibrillator (ICD) was implanted 3 years ago. He was hospitalized briefly for decompensated heart failure 9 months ago, and his medical regimen was intensified at that time. He subsequently resumed his usual activities, which included daily walks of up to several hundred yards around his company’s construction work site and 2 to 3 rounds of golf weekly. His only symptoms were fatigue after 36 holes of golf and shortness of breath while walking uphill rapidly. Medications included 0.125 mg digoxin, 40 mg furosemide, and target doses of an angiotensin-converting enzyme inhibitor, a ß-blocker, and warfarin. An ECG demonstrated atrial fibrillation with a controlled ventricular response. The QRS duration was 130 ms with a left bundle-branch block pattern. On echocardiogram, the left ventricular (LV) ejection fraction (EF) was 23% with anterior wall akinesis; the LV internal diastolic dimension was 83 mm; and there was trace mitral regurgitation. Cardiac resynchronization therapy (CRT) was recommended. Placement of an LV pacing lead and "upgrading" his ICD to an ICD/biventricular pacemaker was performed uneventfully.

Response by Abraham p 2691

Shortly after the procedure, he experienced recurrent ventricular tachyarrhythmias, and his ICD, which had not discharged since implantation, delivered 4 shocks over a 24-hour period to terminate episodes of ventricular fibrillation. There was no evidence of acute myocardial infarction, worsening . . . [Full Text of this Article]

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