Two Implantable Devices for Cardiac Rhythm Management

Published:October 28, 2022DOI:
      A 53-year-old, 104- kg, 165- cm woman with nonischemic cardiomyopathy with a reduced ejection fraction of 30%-to-35% secondary to cardiac sarcoidosis was admitted for decompensated heart failure. She previously had a single-chamber implantable cardioverter-defibrillator (ICD) placed via a left pectoral approach for the primary prevention of sudden cardiac death. Considering that the patient was on maximally tolerable guideline-directed medical therapy for heart failure with reduced ejection fraction, and was not a candidate for cardiac resynchronization therapy, the decision was made to augment her systolic function with a cardiac rhythm management device. After an uneventful implantation of her new device, a chest radiograph (Fig 1) and electrocardiogram showing changes (Fig 2, Fig 3) were obtained. What is the diagnosis?
      Fig 1
      Fig 1Chest x-ray with evidence of implanted cardioverter-defibrillator (red circle) and OPTIMIZER device (blue circle) and 2 right ventricular septal leads (yellow arrows).
      Fig 2
      Fig 2Electrocardiogram with cardiac contractility modulation therapy OFF.
      Fig 3
      Fig 3Electrocardiogram with cardiac contractility modulation therapy ON.
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