Transbaffle, Endocardial Systemic Right Ventricle Cardiac Resynchronization Therapy in D-Transposition of the Great Arteries.

BACKGROUND

Systemic right ventricular (SRV) cardiomyopathy commonly complicates d-transposition of the great arteries with previous atrial switch repair. Cardiac resynchronization therapy (CRT) is an effective therapy but may be difficult to achieve conventionally via coronary sinus (CS) lead implantation.

CASE SUMMARY: A 58-year-old man with a history of d-transposition of the great arteries and prior Mustard procedure presented with progressive dyspnea and QRS duration >200 milliseconds. No suitable CS branch was identified; therefore, we delivered CRT with endocardial SRV lead implantation via a VersaCross radiofrequency wire system. The patient experienced a QRS morphology similar to native conduction and an improvement in his symptoms and cardiac indices.

DISCUSSION: Systemic endocardial pacing has previously been demonstrated to be safe and effective in patients with normal cardiac anatomy.

TAKE-HOME MESSAGES: Endocardial SRV leads for CRT are effective alternatives to CS lead. The VersaCross system is effective in delivering a transbaffle, SRV lead.