Cardiac resynchronization therapy for an unusual cause of cardiomyopathy

Abstract

A 66 year old woman with symptomatic cardiac failure, despite treatment with diuretics, a β-blocker and an ACE inhibitor was referred for consideration of cardiac resynchronization therapy (CRT). Co-morbidity included chronic renal impairment and type II diabetes mellitus. An electrocardiogram demonstrated sinus rhythm, first degree block and left bundle branch block of 160 ms duration. Coronary angiography was normal and transthoracic 2D echocardiography showed severe left ventricular systolic dysfunction with extensive and abnormal trabeculation of the left ventricular lateral, anterior and apical segments. Significant interventricular dys-synchrony (63 ms delay in left vs. right ventricular ejection on Doppler) and intra-ventricular dyssynchrony of the left ventricle were also found (208 ms delay in posteroseptal vs. anteroseptal peak wall thickening on M-mode and with tissue Doppler a 220 ms delay of the basal lateral vs. basal septal segment peak systolic velocity). Moreover, the appearances were highly suggestive of isolated