Dynamic left ventricular dyssynchrony and severe mitral regurgitation caused by exercise: should we go beyond the guidelines?

Abstract

Emilie Laflamme,1 François Philippon,1 Kim O’Connor,1 Jean-François Sarrazin,1 Vincent Auffret,1 Vincent Chauvette,1 Michelle Dubois,2 Pierre Voisine,3 Sébastien Bergeron,1 Mario Sénéchal1 1Department of Cardiology, 2Research Center, 3Department of Cardiovascular Surgery, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Quebec City, QC, Canada Abstract: Guidelines for cardiac resynchronization therapy (CRT) have been established, but there may be a subgroup of patients not identified in these guidelines who may benefit from this therapy. We report a patient with a dynamic left ventricular dyssynchrony and severe mitral regurgitation caused by exercise successfully treated with CRT. Exercise testing should be considered in patients with left ventricular ejection fraction <35% and QRS <130 ms with severe heart failure symptoms that are unexplained by rest echocardiography evaluation in order to rule out ischemia and/or dynamic left ventricular dyssynchrony. In the presence of exercise-induced left ventricular bundle branch block, the implantation of CRT should be contemplated. Keywords: cardiac resynchronization therapy, mitral regurgitation, left ventricular dyssynchrony, heart failure, exercise

Keywords

• cardiac resynchronization therapy
• mitral regurgitation
• left ventricular dyssynchrony
• heart failure
• exercise.