P1571Right ventricular resynchronization: a therapeutic option for right ventricular failure when everything else fails?

Abstract

Introduction: Bifocal pacing of the right ventricle has been reported as a possible therapeutic option in cases of isolated right ventricular failure. In the present report, intraoperative trans-thoracic echocardiography was used to select right ventricular bifocal pacing sites and to determine effect of right ventricular resynchronization on right ventricular function at one-year follow-up. Case report: A 32 year old male was admitted to our cardiac surgery department with two-years history of progressive dyspnea until functional class NYHA IV and syncope. Electrocardiogram, echocardiographic and cardiac magnetic resonance findings confirmed the diagnosis of right ventricular dysplasia with severe rightsided heart failure, and intracardiac defibrillator was recommended. We considered bifocal right ventricular pacing guided by intra-operative trans-thoracic echocardiography to determine its effect on right ventricular function. Acute improvements in echocardiographic criteria for right ventricular function were detected with bifocal pacing (one at the right ventricular apex and the other at right ventricular outflow tract) in comparison with single apical pacing. One-year follow-up confirmed the echocardiographic parameters enhancement and remarkable clinical improvement (table 1). Conclusions: This case shows that resynchronization of the right ventricle may be considered as a novel therapeutic option for patients with severe right ventricular failure. Further randomized studies are needed to define selection criteria. (Figure Presented).