Cardiac resynchronization therapy in a patient with total correction of tetralogy of Fallot and right ventricular lead dysfunction

Abstract

Abstract. Adults with congenital heart lesions constitute a rapidly growing group of patients with cardiovascular disease, with patients with surgically corrected Tetralogy of Fallot forming one of the most complex groups in terms of long-term therapeutic management. Although it can be surgically repaired, Tetralogy of Fallot remains a progressive condition in which heart failure becomes the main determinant of long-term clinical outcomes and mortality. Cardiac resynchronization therapy has a well-established role in the treatment of left ventricular systolic dysfunction with interventricular dyssynchrony, either due to left bundle branch block or due to chronic right ventricular pacing. Here, we present a case of a 52-year-old male patient with Tetralogy of Fallot who underwent radical surgical correction. The patient experienced the typical progression of conduction abnormalities associated with this defect, requiring permanent pacemaker implantation. Because of confirmed septal dyskinesia and borderline left ventricular function (Left Ventricular Ejection Fraction of 45%), the patient was referred for cardiac resynchronization therapy pacemaker. Precise anatomical assessment of the new pacing system and postoperative status was assessed by multislice cardiac computed tomography. This case illustrates the critical transition from conventional pacing to cardiac resynchronization therapy pacemaker. During the 8-month follow-up, achieving electromechanical synchrony in both the left ventricle and right ventricle was confirmed, resulting in significant clinical improvement.