Cardiac resynchronization therapy for management of congestive heart failure after repair of tetralogy of Fallot in an elderly patient.

A 65-year-old woman underwent total correction of tetralogy of Fallot with closure of ventricular septal defect, right ventricular outflow patch, pulmonary valve replacement and tricuspid valve repair. Pacemaker implantation using epicardial electrodes was simultaneously needed because she had complete atrioventricular block. The postoperative course was excellent. Eighteen months postoperatively, she was admitted with severe congestive heart failure and frequent ventricular arrhythmia. Echocardiography and cardiac catheterization revealed depressed left ventricular function caused by conduction delay. Cardiac resynchronization therapy with a defibrillation system was effective for improvement of left ventricular function. Ventricular contractility rapidly recovered to normal, and the patient has been asymptomatic for two years since implantation.