Treatment strategy for heart failure complicated with complete left bundle branch block and atrial tachycardia: a case report
Abstract Background For patients with heart failure combined with complete left bundle branch block, cardiac resynchronization therapy is an important therapeutic method. If these patients also have atrial tachycardia, how to choose a treatment strategy deserves discussion. Case presentation A Chine...
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| Format: | Article |
| Language: | English |
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BMC
2024-01-01
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| Series: | Journal of Medical Case Reports |
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| Online Access: | https://doi.org/10.1186/s13256-024-04343-3 |
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| author | Jian Wang Qing-Qing Zhang Jie Lin Wei Yuan Li-Chun Wang Yu-Cheng Wu |
| author_facet | Jian Wang Qing-Qing Zhang Jie Lin Wei Yuan Li-Chun Wang Yu-Cheng Wu |
| author_sort | Jian Wang |
| collection | DOAJ |
| description | Abstract Background For patients with heart failure combined with complete left bundle branch block, cardiac resynchronization therapy is an important therapeutic method. If these patients also have atrial tachycardia, how to choose a treatment strategy deserves discussion. Case presentation A Chinese woman in her early 70s was admitted due to recurrent episodes of chest distress and asthma for 1 year. Physical and laboratory examinations showed filling of the jugular vein, lung rales, left enlargement of the heart boundary, edema of the lower limbs and elevation of N-terminal pro b-type natriuretic peptide. An electrocardiogram showed atrial tachycardia and a left bundle branch block. An echocardiography revealed enlargement of the left ventricle and left ventricular systolic dysfunction. After obtaining informed consent, the treatment strategy decided upon by the team was to use biventricular cardiac resynchronization therapy treatment and to not intervene for the atrial tachycardia, with left bundle branch area pacing as a backup. Due to twisted and narrow coronary vein branches, traditional biventricular pacing failed, and then, left bundle branch area pacing was attempted successfully. A follow-up echocardiography at 1 year showed improved systolic function. The outcomes for this patient are favorable, but the choice of interventional strategy is worthy of discussion in this case. Conclusion For patients with heart failure combined with left bundle branch block and atrial tachycardia, left bundle branch area pacing can replace traditional biventricular pacing for cardiac resynchronization therapy treatment, and the therapeutic effect is significant. However, multiple factors need to be considered when formulating strategies, including whether there is bundle branch block under sinus rhythm, the success and recurrence rate of atrial tachycardia ablation, the response of cardiac resynchronization therapy, the costs of different strategies, and instrument implantation issues. |
| first_indexed | 2024-03-07T15:30:15Z |
| format | Article |
| id | doaj.art-f6a584cfd2af403da22a2f89964ef02f |
| institution | Directory Open Access Journal |
| issn | 1752-1947 |
| language | English |
| last_indexed | 2024-03-07T15:30:15Z |
| publishDate | 2024-01-01 |
| publisher | BMC |
| record_format | Article |
| series | Journal of Medical Case Reports |
| spelling | doaj.art-f6a584cfd2af403da22a2f89964ef02f2024-03-05T16:30:55ZengBMCJournal of Medical Case Reports1752-19472024-01-011811610.1186/s13256-024-04343-3Treatment strategy for heart failure complicated with complete left bundle branch block and atrial tachycardia: a case reportJian Wang0Qing-Qing Zhang1Jie Lin2Wei Yuan3Li-Chun Wang4Yu-Cheng Wu5Department of Cardiology, The Affiliated Taizhou People’s Hospital of Nanjing Medical University, Taizhou School of Clinical Medicine, Nanjing Medical UniversityDepartment of Endocrinology, The Affiliated Taizhou People’s Hospital of Nanjing Medical University, Taizhou School of Clinical Medicine, Nanjing Medical UniversityDepartment of Cardiology, The Affiliated Taizhou People’s Hospital of Nanjing Medical University, Taizhou School of Clinical Medicine, Nanjing Medical UniversityDepartment of Cardiology, The Affiliated Taizhou People’s Hospital of Nanjing Medical University, Taizhou School of Clinical Medicine, Nanjing Medical UniversityDepartment of Cardiology, The Affiliated Taizhou People’s Hospital of Nanjing Medical University, Taizhou School of Clinical Medicine, Nanjing Medical UniversityDepartment of Cardiology, The Affiliated Taizhou People’s Hospital of Nanjing Medical University, Taizhou School of Clinical Medicine, Nanjing Medical UniversityAbstract Background For patients with heart failure combined with complete left bundle branch block, cardiac resynchronization therapy is an important therapeutic method. If these patients also have atrial tachycardia, how to choose a treatment strategy deserves discussion. Case presentation A Chinese woman in her early 70s was admitted due to recurrent episodes of chest distress and asthma for 1 year. Physical and laboratory examinations showed filling of the jugular vein, lung rales, left enlargement of the heart boundary, edema of the lower limbs and elevation of N-terminal pro b-type natriuretic peptide. An electrocardiogram showed atrial tachycardia and a left bundle branch block. An echocardiography revealed enlargement of the left ventricle and left ventricular systolic dysfunction. After obtaining informed consent, the treatment strategy decided upon by the team was to use biventricular cardiac resynchronization therapy treatment and to not intervene for the atrial tachycardia, with left bundle branch area pacing as a backup. Due to twisted and narrow coronary vein branches, traditional biventricular pacing failed, and then, left bundle branch area pacing was attempted successfully. A follow-up echocardiography at 1 year showed improved systolic function. The outcomes for this patient are favorable, but the choice of interventional strategy is worthy of discussion in this case. Conclusion For patients with heart failure combined with left bundle branch block and atrial tachycardia, left bundle branch area pacing can replace traditional biventricular pacing for cardiac resynchronization therapy treatment, and the therapeutic effect is significant. However, multiple factors need to be considered when formulating strategies, including whether there is bundle branch block under sinus rhythm, the success and recurrence rate of atrial tachycardia ablation, the response of cardiac resynchronization therapy, the costs of different strategies, and instrument implantation issues.https://doi.org/10.1186/s13256-024-04343-3Heart failureComplete left bundle branch blockLeft bundle branch area pacingAtrial tachycardiaCase report |
| spellingShingle | Jian Wang Qing-Qing Zhang Jie Lin Wei Yuan Li-Chun Wang Yu-Cheng Wu Treatment strategy for heart failure complicated with complete left bundle branch block and atrial tachycardia: a case report Journal of Medical Case Reports Heart failure Complete left bundle branch block Left bundle branch area pacing Atrial tachycardia Case report |
| title | Treatment strategy for heart failure complicated with complete left bundle branch block and atrial tachycardia: a case report |
| title_full | Treatment strategy for heart failure complicated with complete left bundle branch block and atrial tachycardia: a case report |
| title_fullStr | Treatment strategy for heart failure complicated with complete left bundle branch block and atrial tachycardia: a case report |
| title_full_unstemmed | Treatment strategy for heart failure complicated with complete left bundle branch block and atrial tachycardia: a case report |
| title_short | Treatment strategy for heart failure complicated with complete left bundle branch block and atrial tachycardia: a case report |
| title_sort | treatment strategy for heart failure complicated with complete left bundle branch block and atrial tachycardia a case report |
| topic | Heart failure Complete left bundle branch block Left bundle branch area pacing Atrial tachycardia Case report |
| url | https://doi.org/10.1186/s13256-024-04343-3 |
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