72-year-old man implanted with a triple-chamber defibrillator Viva XT CRT-D for ischemic cardiomyopathy with atypical bundle branch block and episodes of atrial fibrillation; device interrogation performed a few days after implant.
Atrial fibrillation is probably the most common cause of prolonged loss of biventricular pacing in CRT patients with a preserved atrioventricular conduction. These episodes are regularly associated with a rapid deterioration of hemodynamics through several combined mechanisms: increased heart rate, irregular ventricular rhythm with short diastole and LV filling disorder, loss of atrial systole and loss of biventricular resynchronization… This patient had multiple episodes of paroxysmal atrial arrhythmias that were not effectively controlled by the antiarrhythmic treatment. He was successfully treated by a pulmonary vein isolation procedure. The combined effect of ablation and resynchronization resulted in a significant improvement of the patient’s symptomatology and in a reduction of ventricular volumes.
