Successful bridge to resynchronization therapy with a left ventricular assist system in a patient with idiopathic dilated cardiomyopathy

• Published in: Journal of artificial organs 2005-09, Vol.8 (3), p.210-213
• Main Authors: Nishimura, Motonobu, Ogiwara, Masanori, Ishikawa, Masayuki, Imanaka, Kazuhito, Okamura, Nobuyuki, Kato, Masaaki, Asano, Haruhiko, Katogi, Toshiyuki, Kohmoto, Osami, Matsumoto, Kazuo, Nishimura, Shigeyuki, Kyo, Shunei
• Format: Article
• Language: English
• Subjects: Adult; Cardiology; Cardiomyopathy, Dilated - complications; Cardiomyopathy, Dilated - physiopathology; Cardiomyopathy, Dilated - therapy; Device Removal; Electrocardiography; Heart failure; Heart Failure - etiology; Heart Failure - therapy; Heart-Assist Devices; Humans; Male; Pacemaker, Artificial; Stroke Volume; Ventricular Function, Left
• ISSN: 1434-7229; 1619-0904
• DOI: 10.1007/s10047-005-0304-1

Implantation of a left ventricular assist system (LVAS) in patients with idiopathic dilated cardiomyopathy (DCM) may improve cardiac function and allow explantation of the device. Generally, an ejection fraction of more than 40% is considered necessary for successful weaning from an LVAS, but less than 10% of DCM patients with an LVAS can achieve such a significant recovery of cardiac function. Cardiac resynchronization therapy, or atrial-synchronized biventricular pacing, has been found to treat congestive heart failure and ventricular dyssynchrony effectively. Here we report on a patient with an LVAS, in whom enough functional recovery could be obtained with resynchronization therapy for the device to be explanted successfully. A 32-year-old man was implanted with a Toyobo-NCVC paracorporeal LVAS to treat his intractable heart failure caused by idiopathic dilated cardiomyopathy. While on the LVAS for 8 months, his cardiac function recovered to some extent. The ejection fraction of his left ventricle (LVEF) improved from 9% to 41%. He chose explantation of the device rather than heart transplantation. Because he occasionally showed a wide QRS pattern on his ECG, epicardial biventricular pacing leads as well as a biventricular pacemaker were implanted on LVAS explantation surgery. An echocardiogram 2 weeks after explantation showed a marked difference in his LVEF by switching his biventricular pacing on and off (40% with biventricular pacing on and 29% with it off). Biventricular pacing may help recovery of cardiac function in selected LVAS patients and contribute to the increase in bridge to recovery cases.