SUCCESSFUL BIVENTRICULAR PACING IN AN ELDERLYPATIENT WITH CARDIAC SARCOIDOSIS AT RISK OFCONGESTIVE HEART FAILURE

摘要

We report on a successful caridiac resynchronization therapy (CRT) in a patient with congestive heart failure (CHF) caused by cardiac sarcoidosis with mitral regurgitation (MR) and paroxysmal atrial ftutto-fibrillation (PAF/AFL). A 78 year-old woman was transferred because of CHF. She was diagnosed with uveitis and cardiac sarcoidosis by echo cardiography, CAG and LVG in 1996. VDD pacemaker was implanted to treat the advanced AV block in 1997. She had been given amiodarone for ventricular tachycardia since 1999. In 2003, she was admitted because of progressive CHF with pulmonary congestion and severely impaired left ventricular function with 19% of ejection fraction (EF) due to PAF/AFL. To prevent from CHF, biventricular pacing was undertaken on Mar, 2003. The left ventricular pacing lead was connected with the previously implanted generater with Y connector. Her functional class improved from NYHA HI to n. The QRS duration decreased from 209 to 160msec a year later. Plasma brain natriuretic peptide levels decreased from 691 to 240pg/ml. Left ventricular end-diastolic dimension decreased 75 to 70mm, EF increased from 19 to 41% and the grade of MR improved from K to II. Bi-ventricular pacing may be a successful tool in an elderly patient with CHF at risk for dyssynchrony of cardiac sarcoidosis besides during PAF/ALF.