Effective Case of Cardiac Resynchronization Therapy (CRT) in Congestive Heart Failure Patient with Old and Broad Myocardial Infarction after Coronary Artery Bypass Graft (CABG)

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Case is female and seventy-three years old. He had admitted first to our hospital for worsening congestive heart failure. He had high BNP level (1500 pg/ml), low cardiac function (ejection fraction, 24%) and left ventricle (LV) wall thinning of anterior, intra ventricular septum, apex and posterior aria. It was difficult to evaluate LV dissynchrony because of broad infarction. After improved his condition using diuretic drugs and vasodilator, we performed cardiac catheterization. Coronary angiography showed occlusion of right coronary artery and left antero-descending artery. Left ventriculography showed LV dilatation and diffuse severe hypokinesis and/or akinesis. He was performed CABG, and he discharged after one month of operation. After that, he had re-hospitalized two times for worsening congestive heart failure. His condition showed drug-resistant situation, NYHA class IV, low LV function, his ECG indicated wide QRS (170 msec, RBBB type) and non-sustained ventricular tachycardia. We performed CRT-D implantation with his consent. After implantation, his condition was smoothly improved (NYHA II, lower BNP (394 pg/ml), increased exercise tolerance). <B>Conclusion:</B> In this case, additional CRT therapy to releasing cardiac ischemia dramatically improved the state of congestive heart failure with old and broad myocardial infarction.