Cardiac resynchronization therapy in acute pulmonary edema: A case report

Abstract

We are reporting a case of 71-year old lady with a dual chamber demand pacemaker, who developed acute pulmonary edema due to an acute left ventricular (LV) dysfunction and worsening in mitral valve regurgitation after atrioventricular nodal ablation for uncontrolled atrial fibrillation. This was attributed to right ventricular apical pacing leading to LV dyssynchronization. Patient dramatically improved within 12-24 h after upgrading her single chamber pacemaker to biventricular pacing. Our case demonstrates that biventricular pacing can be an effective modality of treatment of acute congestive heart failure. In particular, it can be used when it is secondary to LV dysfunction and severe mitral regurgitation attributed to significant dyssynchrony created by right ventricular pacing in patients with atrioventricular nodal ablation for chronic atrial fibrillation.

Keywords: Acute congestive heart failure; Cardiac resynchronization therapy pacemaker; Pacing; Cardiac biventricular pacing

Core tip: Our case demonstrates that biventricular pacing (cardiac resynchronization therapy pacemaker, CRT-P) can be an effective modality of treatment in acute congestive heart failure. In particular, it can be used when it is secondary to left ventricular dysfunction and severe mitral regurgitation attributed to significant dyssynchrony created by right ventricular pacing in patients with atrioventricular (AV) nodal ablation for chronic atrial fibrillation. our case matches recent update to guidelines that CRT can be useful in patients with atrial fibrillation and left ventricular ejection fraction (LVEF) ≤ 35% if AV nodal ablation will allow ventricular pacing with CRT except our patient has LVEF > 35%.