Pérdida de estimulación biventricular continua en pacientes con terapia de resincronización cardiaca: incidencia, causas y resultados / Loss of continuous biventricular pacing in cardiac resynchronization therapy patients: incidence, causes, and outcomes

Introducción y objetivos. En los últimos años se ha asistido a un gran aumento en el número de implantes de dispositivos cardiacos con terapia de resincronización cardiaca. Los beneficios obtenidos con dicha terapia están directamente relacionados con el mantenimiento de la estimulación biventricular continua. Este trabajo analiza la incidencia de pérdida de estimulación biventricular, sus causas, la actitud adoptada y los resultados. Métodos. Se analizaron los datos clínicos y de seguimiento de una serie de pacientes consecutivos de un centro a los que se implantó un dispositivo con terapia de resincronización cardiaca. Resultados. Se estudió a un total de 136 pacientes. Durante un seguimiento medio de 33,4 meses, 45 pacientes (33%) sufrieron pérdida de estimulación biventricular continua. Las causas más frecuentes fueron las taquiarritmias auriculares (21,3%), seguidas de la dislocación de cables (18%) y el fallo de captura del cable de ventrículo izquierdo (13,1%). La pérdida de estimulación biventricular continua fue transitoria y corregible en la mayoría (88,5%) de los casos y ocurrió más precozmente en los casos de dislocación de cables, sobresensado y estimulación extracardiaca. No hubo diferencias significativas de mortalidad entre los grupos de pacientes con y sin pérdida de estimulación biventricular continua (p=0,88). Conclusiones. Pese a los avances técnicos en la terapia de resincronización cardiaca, la pérdida de la estimulación biventricular continua es una situación clínica frecuente pero corregible en la mayoría de los casos. Un seguimiento estrecho de los pacientes y una actitud proactiva garantizan lograr la estimulación biventricular continua en la mayoría de los pacientes (AU)

Introduction and objectives. In recent years, implantation of cardiac resynchronization therapy devices has significantly increased. The benefits of this therapy are directly related to the maintenance of continuous biventricular pacing. This study analyzed the incidence, causes, and outcomes of loss of continuous biventricular pacing, and the approach adopted. Methods. We analyzed the clinical and follow-up data of a series of consecutive patients from a single center who underwent implantation of a cardiac resynchronization therapy device. Results. The study included 136 patients. During a mean follow-up of 33.4 months, loss of continuous biventricular pacing occurred in 45 patients (33%). The most common causes included atrial tachyarrhythmias (21.3%), lead macrodislodgement (18%), and loss of left ventricular capture (13.1%). In most patients (88.5%), loss of continuous biventricular pacing was transient and correctable, and occurred earlier in the follow-up when the cause was lead macrodislodgement, oversensing, or extracardiac stimulation. There were no significant differences in mortality between patients with and without loss of continuous biventricular pacing (P=.88). Conclusions. Despite technical advances in cardiac resynchronization therapy, loss of continuous biventricular pacing is common; however, this loss can usually be corrected. In most patients, continuous biventricular pacing can be ensured by close monitoring and follow-up and a proactive approach (AU)

Loss of continuous biventricular pacing in cardiac resynchronization therapy patients: incidence, causes, and outcomes.

INTRODUCTION AND OBJECTIVES: In recent years, implantation of cardiac resynchronization therapy devices has significantly increased. The benefits of this therapy are directly related to the maintenance of continuous biventricular pacing. This study analyzed the incidence, causes, and outcomes of loss of continuous biventricular pacing, and the approach adopted. METHODS: We analyzed the clinical and follow-up data of a series of consecutive patients from a single center who underwent implantation of a cardiac resynchronization therapy device. RESULTS: The study included 136 patients. During a mean follow-up of 33.4 months, loss of continuous biventricular pacing occurred in 45 patients (33%). The most common causes included atrial tachyarrhythmias (21.3%), lead macrodislodgement (18%), and loss of left ventricular capture (13.1%). In most patients (88.5%), loss of continuous biventricular pacing was transient and correctable, and occurred earlier in the follow-up when the cause was lead macrodislodgement, oversensing, or extracardiac stimulation. There were no significant differences in mortality between patients with and without loss of continuous biventricular pacing (P=.88). CONCLUSIONS: Despite technical advances in cardiac resynchronization therapy, loss of continuous biventricular pacing is common; however, this loss can usually be corrected. In most patients, continuous biventricular pacing can be ensured by close monitoring and follow-up and a proactive approach.

Unusual case of new-onset heart failure due to cor triatriatum sinister.

We report the case of a 30-year old man who came to the emergency department of our hospital with acute left heart failure, and was diagnosed with a rare congenital anomaly (cor triatriatrum sinister), which can mimic a severe mitral stenosis. Cor triatriatum sinister is a rare anomaly (0.1% of all cases of congenital heart disease) that is seldom diagnosed in adult patients. The hallmark of this congenital defect is the presence of a fibromuscular membrane that divides the left atrium (LA) into two chambers: a postero-superior chamber into which the pulmonary veins drain and an infero-anterior chamber (true LA) containing the mitral valve and atrial appendage. Both chambers communicate through a membrane in which one or more drain holes can be found. When the hole is significantly obstructive, it results in increased venous and arterial pressures. Even though the definitive treatment of cor triatriatum is the surgical excision of the membrane, we present a balloon dilatation case with a good response to percutaneous therapy, both initially and in the ensuing months.

Endocarditis trombótica no bacteriana e insuficiencia valvular aórtica grave. Resolución tras quimioterapia / Nonbacterial thrombotic endocarditis and severe aortic valve regurgitation. Resolution after chemotherapy

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Loss of biventricular pacing due to T-wave oversensing.

The benefits obtained with cardiac resynchronization therapy are directly related to the occurrence of continuous biventricular pacing. We report a case of intermittent loss of biventricular pacing due to ventricular oversensing that worsened the functional status of the patient.