Do patients with heart failure and right bundle branch block need biventricular pacing? A case of significant QRS narrowing by right ventricular pacing alone

J Electrocardiol. 2015 Jan-Feb;48(1):71-3. doi: 10.1016/j.jelectrocard.2014.10.009. Epub 2014 Oct 30.

Abstract

We report the case of a 56-year-old male with ischemic cardiomyopathy, severe left ventricular dysfunction and right bundle branch block (RBBB) with a wide QRS duration (180ms) who received dual-chamber implantable cardioverter-defibrillator for primary prevention of sudden death. After having placed the right ventricular lead in the middle of the inter-ventricular septum, a significant narrowing of QRS duration was observed, thus obtaining "de facto" a cardiac resynchronization therapy (CRT). This type of cardiac pacing could be an alternative to conventional CRT with left ventricular pacing in patients with wide QRS due to RBBB. The long-term effects of this RV only pacing strategy with ICD in patients with heart failure yet remain to be determined.

Keywords: AV delay; Heart failure; Resynchronization therapy; Right bundle branch block; Ventricular pacing.

Publication types

  • Case Reports

MeSH terms

  • Bundle-Branch Block / complications
  • Bundle-Branch Block / diagnosis*
  • Bundle-Branch Block / prevention & control*
  • Cardiac Resynchronization Therapy Devices*
  • Defibrillators, Implantable*
  • Electrocardiography / methods
  • Heart Failure / diagnosis*
  • Heart Failure / etiology
  • Heart Failure / prevention & control*
  • Humans
  • Male
  • Middle Aged
  • Treatment Outcome
  • Ventricular Dysfunction, Right / diagnosis
  • Ventricular Dysfunction, Right / etiology
  • Ventricular Dysfunction, Right / prevention & control