A Case of Refractory Heart Failure Successfully Managed by Optimization of the Intra-Cardiac Conduction Delays Using Smart Delay

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Background: Optimal atrial-ventricular (AV) and intra-ventricular (VV) conduction delay setting is mandatory for maintaining left ventricular pump function in patients who have undergone cardiac resynchronization therapy (CRT). Echocardiography is considered the gold standard of timing optimization but is a time-consuming procedure. Purpose: We report an interesting case of refractory heart failure who were successfully managed by algorithmic AV and VV delay programming using Smart Delay algorithm. Case: A 54-year-old female patient. The patient was diagnosed as NYHA III degree heart failure in September 2008, CRT-D was implanted in October 2008. In late December 2009, the patient was diagnosed as NYHA IV degree heart failure, and the patient was transferred to our hospital for the treatment of arrhythmias and heart failure. Therapy: optimization of the intra-cardiac conduction delays was achieved using Smart Delay algorithm (paced AV 160 to 180 msec, sensed AV 160 to 180 msec, and BIV pacing to LV pacing), which resulted in a prompt increase in her stroke volume from 46 to 80 ml with consequent improvement in heart failure symptoms. Conclusion: We experienced a case of refractory heart failure successfully managed by optimization of the intra-cardiac conduction delays using Smart Delay.