Biventricular with Multi-Site Left-Ventricular Pacing for the Management of Refractory Ventricular Tachycardia in a Patient with Narrow Complex QRS – Case Report

A patient with non-ischemic cardiomyopathy, advanced heart failure, narrow complex QRS, >40% premature ventricular complexes (PVCs) and recurrent sustained monomorphic ventricular tachycardia (VT) episodes had failed pharmacotherapy and recurrent VT ablations. A trans-venous biventricular defibrillator with multi-site LV pacing (MS-CRTD) was implanted (i.e. two left ventricular (LV) leads through the coronary sinus and one right ventricular lead). Immediate reduction in PVCs burden was inspected. Within one year PVCS and VTs subsided, antiarrhythmic medications were discontinued, and LV function and heart failure symptoms improved dramatically. The case suggests that biventricular multi-site LV pacing may serve as an alternative option for treating refractory VT. Further studies to assess this technique and the underlying mechanism are warranted.