Case 42: A 68-Year-Old Woman in Congestive Heart Failure
History
Diagnosis
ECG 2
ECG 2 Diagnosis
History
This 68-year-old woman with non-ischemic cardiomyopathy is in hospital with severe congestive heart failure, despite optimal drug therapy:
Diagnosis
- Sinus rhythm, 70/min
- Left bundle branch block
- QRS duration 160 msec
ECG 2
Echocardiography demonstrated a severely impaired ejection fraction (22%). The patient remained in heart failure despite vigorous medical therapy. She is referred to the Electrophysiology (EP) Service, and a therapeutic procedure is performed:
ECG 2 Diagnosis
- Electronic Ventricular Pacemaker
- Sinus rhythm, 73/min, with AV-sequential ventricular pacing
- Right-superior QRS axis (265 degrees)
- In keeping with biventricular pacing (CRT)
CRT (Cardiac Resynchronization Therapy) is achieved through simultaneous pacing of both ventricles (biventricular pacing), and has been proven to yield clinical benefits and improve survival in patients with heart failure, low left ventricular ejection fraction, and marked intraventricular conduction delay. In biventricular pacing, the mean QRS axis is directed to the right and superiorly, while in right ventricular apex pacing there is left axis deviation. This patient has 3 pacemaker leads: in the right atrial appendage, the right ventricular apex, and a lateral coronary venous branch. The left ventricle is paced first, with the right ventricle 40 msec later.
ECG ID: E639