Abstract
A 55-year-old man with nonischemic cardiomyopathy (left ventricular ejection fraction 0.25), New York Heart Association class III heart failure, nonspecific intraventricular conduction delay (QRS duration 130 ms), frequent ventricular ectopy, and recent implantation of a Boston Scientific CONTAK RENEWAL 3 HE H177 cardiac resynchronization therapy (CRT) defibrillator presented to the clinic with persistent heart failure symptoms and only 50% biventricular pacing. Programmed parameters were as follows: mode: DDDR; lower rate: 70 ppm; upper rate: 160 ppm; paced atrioventricular (AV) delay: 190 ms; sensed AV offset: −50 ms; left ventricular (LV) pacing offset: −40 ms; postventricular atrial refractory period (PVARP): dynamic (170–250 ms); and rate smoothing: up 3%, down off.
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