Upgrade from ICD to CRT-D: clinical and haemodynamic impact of biventricular pacing in a patient with acquired long QT syndrome

Abstract

Long QT syndrome (LQTS) is characterised by both the depolarisation and repolarisation disorder of cardiac muscle cells. Cardiac resynchronising therapy (CRT) is an important treatment option for patients with chronic heart failure (CHF) when echocardiographic and electrocardiographic criteria are met. Although CRT was introduced in clinical practice 10 years ago, doubts related to application of this treatment method persist because of its potential proarrhythmogenic effect. This is a case describing a 66-year-old Caucasian female with LQTS coexisting with a left bundle branch branch block (LBBB) and an implantable single-cavity cardioverter-defibrillator (ICD VR), who had repeated appropriate high-energy treatments. The upgrade to resynchronisation therapy defibrillator (CRT-D) significantly reduced frequency of ventricular tachycardia and the need for electrical therapies. The normalisation of the left ventricle size, as seen on echo examination, and the improvement of heart failure symptoms were also observed.

Keywords

• long QT syndrome (LQTS)
• cardiac resynchronising therapy (CRT)
• resynchronisation therapy defibrillator (CRT-D)
• implantable cardioverter-defibrillator (ICD)
• polymorphic ventricular tachycardia
• Torsade de Pointes (TdP)
• heart failure (HF)