Histopathology of the Posterolateral Myocardium in a Responder to Cardiac Resynchronization Therapy

Abstract

We present a 72-year-old man with idiopathic dilated cardiomyopathy, who was in New York Heart Association class III and had left ventricular (LV) dyssynchrony on tissue Doppler imaging. Cardiac resynchronization therapy (CRT) was performed for his heart failure, which improved to class I. Two years later, ventricular arrhythmias recurred, resulting in death. The LV posterior vein containing a pacing lead showed half-circumferential fibrous thickening. The LV myocardium of this region was relatively well preserved, and interstitial fibrosis due to cardiomyopathy was mild. Absence of a massive fibrotic scar on the LV posterior wall and positioning of the pacing lead in the optimal coronary vein (a posterolateral vein) might have been positive factors determining this patient's response to CRT.

Keywords

• Cardiac resynchronization therapy
• Pathologic finding
• Coronary vein pacing
• Idiopathic dilated
• cardiomyopathy