Adaptive cardiac resynchronization therapy for dilated cardiomyopathy with functional mitral regurgitation

We report the case of a man in his 60s who had dilated cardiomyopathy with severe functional mitral regurgitation. Four years after a cardiac resynchronization therapy (CRT) device with an implantable cardioverter defibrillator was implanted, this device was replaced with an adaptive CRT device because of battery consumption. Seven months after replacement of this device, the left ventricular pacing to right ventricular activation and the atrioventricular delay from automatic adjustments contributed to less functional mitral regurgitation. The findings from our case suggest that optimal CRT, by measuring intracardiac conduction parameters, is effective for functional mitral regurgitation

Magnetic resonance imaging in a patient with an implantable cardiac defibrillator

A 58-year-old man, in whom an implantable cardiac defibrillator (ICD) had been implanted for Brugada syndrome, suffered rapidly progressive general paralysis. Various diagnostic imaging techniques were performed, but the cause could not be determined. Magnetic resonance imaging (MRI) scanning was performed. A 1.5-Tesla MRI system was used, and the ICD was programmed to ODO mode and all tachycardia detection was turned off. MRI was performed safely under electrocardiogram and pulse oximeter monitoring, and appropriate precautions were taken in preparation for an emergency. ICD parameters did not change in post-imaging investigations. MRI revealed an apparent tumor in the patient's medulla and upper cervical spinal cord, which was diagnosed as high-grade astrocytoma. When performing MRI procedures in patients with an ICD under urgent conditions, it is necessary to have complete knowledge of the procedure and to make careful preparations