J Korean Med Sci.  2010 Dec;25(12):1809-1813. 10.3346/jkms.2010.25.12.1809.

Cardiac Resynchronization Therapy for Left Ventricular Dysfunction Induced by Chronic Right Ventricular Pacing in a Child

• Kim HW
• Kim GB
• Bae EJ
• Noh CI
• Kim WH
• Kim HS

• KMID: 1792909
• DOI: http://doi.org/10.3346/jkms.2010.25.12.1809

Abstract

Cardiac resynchronization therapy (CRT) has been proven its value in adult patients with congestive heart failure of low ejection fraction and wide QRS duration. Contrast to adult patients, CRT has been rarely applied for young patients. We report on a 9-yr-old boy with progressive left ventricular (LV) dilatation and dysfunction following chronic VVI pacemaker therapy for congenital complete atrioventricular block associated with maternal anti-SSA/Ro and SSB/La antibody. His LV dysfunction was improved after epicardially established CRT.

Keyword

Electric Countershock; Atrioventricular Block; Ventricular Dysfunction; Cardiac Pacing, Artificial; Child

MeSH Terms

Antibodies, Antinuclear/metabolism
Atrioventricular Block/congenital/therapy
Cardiac Pacing, Artificial/*adverse effects
*Cardiac Resynchronization Therapy
Child
Chronic Disease
Electrocardiography
Heart Ventricles
Humans
Male
Natriuretic Peptide, Brain/blood
Sjogren's Syndrome/immunology
Ventricular Dysfunction, Left/etiology/radiography/*therapy

Figure

• 

  Fig. 1 Electrocardiographic findings before and after implantation. (A) Electrocardiogram showed complete heart block and wide QRS intrinsic escape rhythm with normal QRS axis. (B) VVI paced rhythm had wide QRS complex of 164 msec with superior axis. (C) Twelve months after implantation, electrocardiogram demonstrated atrial-sensing and ventricular-pacing QRS complex of 148 msec.

• 

  Fig. 2 M mode echocardiography revealed the improvement of left ventricular dilatation and fractional shortening. Panel (A) shows pre-cardiac resynchronization therapy (CRT) and panel (B) shows post-CRT images.

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  Fig. 3 Echocardiographic findings before and after implantation. (A) Tissue strain image at 4 chamber view shows inhomogenous left ventricular (LV) peak global strain (arrow) and markedly decreased septal strain. (B) Twelve months after implantation, echocardiography demonstrated improving LV contractility and rather homogenous LV peak global strain (arrow) than before.

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  Fig. 4 Chest radiography showed the improvement of cardiomegaly. Panel (A) shows pre-cardiac resynchronization therapy (CRT) and panel (B) shows post-CRT images.

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