Author + information
- Received October 27, 2011
- Accepted December 7, 2011
- Published online July 17, 2012.
A 29-year-old man with dilated phased hypertrophic cardiomyopathy and cardiac resynchronization was referred for device optimization because of clinical worsening during the previous months. Initially, the echocardiography showed moderate mitral regurgitation (MR) (Online Video 1). A few minutes later, free MR caused by lack of mitral leaflets coaptation was suddenly observed when output intensity of the left ventricular lead was accidentally reduced (A and B, Online Videos 2 and 3). We also saw equalization of ventricle and atrial pressure (C). The patient showed heart failure signs. As we elevated the output intensity, we achieved better biventricular synchronization. With maximum output, we obtained mitral leaflets coaptation and mild MR (D, Online Videos 4 and 5). Afterward, there was great improvement in the clinical status. The deterioration in the left ventricular lead threshold was the cause of the patient's worsening in the previous months, probably also involving increasing MR.
- Received October 27, 2011.
- Accepted December 7, 2011.
- American College of Cardiology Foundation