Nuances of Cardiac Resynchronization Therapy in Patients with Dilated Cardiomyopathy and Atrial Fibrillation (a Clinical Case)

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Abstract

Dilated cardiomyopathy (DCM) is a steadily developing disease characterized by progressive chronic heart failure (CHF) resistant to drug therapy. Cardiac resynchronization therapy (CRT) significantly improves the prognosis in these patients if they have indications for implantation of resynchronization devices. The article presents a clinical case of successful implantation of a cardioversion-defibrillation cardiac resynchronization device in a patient suffering from DCM in combination with permanent atrial fibrillation (AF). The nuances of ventricular rate control and the role of the catheter procedure for modifying the atrioventricular junction are discussed.

About the authors

Fatima I. Bitakova

North-Western State Medical University named after I.I. Mechnikov

Email: Fatima.Bitakova@szgmu.ru
ORCID iD: 0000-0001-6637-8266
SPIN-code: 8624-7193

Candidate of Sciences in Medicine, Associate Professor

Russian Federation, Saint Petersburg

Victoria E. Gumerova

North-Western State Medical University named after I.I. Mechnikov

Email: vvoron1@yahoo.com
ORCID iD: 0000-0003-2805-3748
SPIN-code: 9872-4799

Assistant

Russian Federation, Saint Petersburg

Elizaveta V. Zbyshevskaya

North-Western State Medical University named after I.I. Mechnikov

Email: zbyshev@hotmail.com
ORCID iD: 0000-0002-2565-3548
SPIN-code: 7761-0942

Candidate of Sciences in Medicine, Associate Professor

Russian Federation, Saint Petersburg

Vera Y. Zimina

North-Western State Medical University named after I.I. Mechnikov

Email: ziminavu@mail.ru
ORCID iD: 0000-0002-5655-8981
SPIN-code: 7202-1071

Candidate of Sciences in Medicine, Associate Professor

Russian Federation, Saint Petersburg

Tatiana N. Novikova

North-Western State Medical University named after I.I. Mechnikov

Author for correspondence.
Email: novikova-tn@mail.ru
ORCID iD: 0000-0003-4655-0297
SPIN-code: 3401-0329

Candidate of Sciences in Medicine, Associate Professor

Russian Federation, Saint Petersburg

Rodion V. Ratmanov

North-Western State Medical University named after I.I. Mechnikov

Email: rodionratmanov.spb@gmail.com

resident

Russian Federation, Saint Petersburg

Sergey A. Saiganov

North-Western State Medical University named after I.I. Mechnikov

Email: sergey.sayganov@szgmu.ru
ORCID iD: 0000-0001-8325-1937
SPIN-code: 2174-6400

Doctor of Medical Sciences, Professor

Russian Federation, Saint Petersburg

Vladislava A. Shcherbakova

North-Western State Medical University named after I.I. Mechnikov

Email: shcher.vl@yandex.ru

student

Russian Federation, Saint Petersburg

References

  1. Kardiologiya. Nacional'noe rukovodstvo. Ed. by E.V. Shlyakhto. Moscow: GEHOTAR-Media; 2019. (In Russ.).
  2. Mathew T, Williams L, Navaratnam G, et al. Diagnosis and assessment of dilated cardiomyopathy: a guideline protocol from the British Society of Echocardiography. Echo Res Pract. 2017;4(2):G1–G13. doi: 10.1530/ERP-16-0037
  3. Novikov VI, Novikova TN. Kardiomiopatii. Moscow: MEDpress-inform; 2021. (In Russ.).
  4. Hronicheskaya serdechnaya nedostatochnost'. Klinicheskie rekomendacii. 2020 [Internet]. Available from: https://scardio.ru/content/Guidelines/2020/Clinic_rekom_HSN.pdf. Accessed: Dec 13, 2021. (In Russ.).
  5. Ponikowski P, Voors AA, Anker SD, et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Eur J Heart Fail. 2016;18(8):891–975. doi: 10.1002/ejhf.592
  6. McLeod CJ, Shen W-K, Rea RF, et al. Differential outcome of cardiac resynchronization therapy in ischemic cardiomyopathy and idiopathic dilated cardiomyopathy. Heart Rhythm. 2011;8(3):377–382. doi: 10.1016/j.hrthm.2010.11.013
  7. Upadhyay GA, Choudhry NK, Auricchio A, et al. Cardiac resynchronization in patients with atrial fibrillation: a meta-analysis of prospective cohort studies. J Am Coll Cardiol. 2008;52(15): 1239–1246. doi: 10.1016/j.jacc.2008.06.043
  8. Lawin D, Stellbrink C. Change in indication for cardiac resynchronization therapy? Eur J Cardiothorac Surg. 2019;55 (Suppl 1):i11–i16. doi: 10.1093/ejcts/ezy488

Supplementary files

Supplementary Files
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2. Fig. 1. Fragment of ECG monitoring after CRT-D implantation, explanation in the text.

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3. Fig. 2. Two fragments of 24-hour ECG monitoring after destruction of the AV junction. Explanation in the text.

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Copyright (c) 2021 Bitakova F.I., Gumerova V.E., Zbyshevskaya E.V., Zimina V.Y., Novikova T.N., Ratmanov R.V., Saiganov S.A., Shcherbakova V.A.

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This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

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