Heart Failure Exacerbation Associated with Newly Developed Atrioventricular Dyssynchrony after Chemical Conversion to a Sinus Rhythm in a Patient Receiving Cardiac Resynchronization Therapy

• Published in: Internal Medicine Vol. 52; no. 12; pp. 1359 - 1363
• Main Authors: Sato, Yuichi, Dohi, Kaoru, Kusuki, Hirofumi, Tanimura, Muneyoshi, Watanabe, Kiyotaka, Sugiura, Emiyo, Kumagai, Naoto, Nakamori, Shiro, Nakajima, Hiroshi, Fujii, Eitaro, Nakamura, Mashio, Nobori, Tsutomu, Ito, Masaaki
• Format: Journal Article
• Language: English
• Published: Japan The Japanese Society of Internal Medicine 01-01-2013
• Subjects: Amiodarone - therapeutic use; Anti-Arrhythmia Agents - therapeutic use; atrial fibrillation; Atrial Fibrillation - diagnostic imaging; Atrial Fibrillation - physiopathology; Atrial Fibrillation - therapy; atrioventricular dyssynchrony; cardiac resynchronization therapy; Cardiac Resynchronization Therapy - adverse effects; Defibrillators, Implantable; Echocardiography; Electrocardiography; Female; Heart Block - diagnostic imaging; Heart Block - etiology; Heart Block - physiopathology; heart failure; Heart Failure - diagnostic imaging; Heart Failure - etiology; Heart Failure - physiopathology; Humans; Middle Aged; Pacemaker, Artificial; Treatment Outcome
• ISSN: 0918-2918; 1349-7235
• DOI: 10.2169/internalmedicine.52.0056

A 58-year-old woman with chronic heart failure (CHF) received cardiac resynchronization-defibrillator (CRT-D) therapy without atrial lead implantation due to longstanding atrial fibrillation (AF). Three months after oral amiodarone therapy was initiated for the treatment of non-sustained ventricular tachycardia detected by the CRT-D device, the patient's heart failure symptoms worsened and 12-lead electrocardiography showed newly emerged p-waves with atrioventricular (AV) dissociation. Immediately after the device was upgraded to the DDD-biventricular pacemaker, the patient's heart failure symptoms and cardiac function dramatically improved, which suggests that AV dissociation has a much more negative impact on the cardiac function than AF in patients with CHF.