Simple and effective solution for diaphragm pacing by that uses the transvenous femoral approach in a patient treated with cardiac resynchronization-defibrillator therapy: The wrapping method

The use of cardiac resynchronization therapy (CRT) has become widespread in patients with heart failure who meet the criteria for implantation. Coronary sinus lead positioning is important to provide the intended biventricular stimulation. Diaphragm pacing is a lead-related complication which occurs secondary to phrenic nerve stimulation. We present the case of a 58-year-old male patient who had diaphragm pacing after CRT with defibrillator implantation. The complication was resolved by using the transvenous femoral approach with the wrapping method

Immediate electrical storm of Torsades de Pointes after CRT-D implantation in an ischemic cardiomyopathy patient

Cardiac resynchronization therapy with an implantable cardioverter-defibrillator (CRT-D) is the preferred treatment for patients with severe heart failure, dyssynchrony, and an increased risk of sudden cardiac death or for primary ventricular arrhythmia survivors. Rarely, left ventricular epicardial pacing can induce ventricular tachyarrhythmia rather than a beneficial effect. We describe an ischemic cardiomyopathy patient who underwent CRT-D therapy and developed sustained torsades de pointes (TdP) immediately after switching to biventricular pacing (BVP) mode. Here, TdP possibly developed owing to the change in the dispersion of repolarization of the left ventricle myocardium. The diagnosis and management of BVP-induced ventricular arrhythmia is discussed