Reverse Remodeling Achieved by Combination Therapy With High-Dose Beta Blocker and Cardiac Resynchronization.

Although both beta-blocker treatment and cardiac resynchronization therapy (CRT) have been established as the standard therapeutic strategy to achieve left ventricular reverse remodeling (LVRR) and improve prognosis in heart failure (HF) patients with systolic LV dysfunction, some patients do not respond to such treatments. We here report a HF patient with left bundle branch block due to nonischemic cardiomyopathy who did not respond to 20 mg/day of carvedilol in terms of LVRR. Subsequent CRT only achieved insufficient LVRR, and we further titrated carvedilol up to 40 mg/day. Marked LVRR was accomplished at a fixed 70 bpm heart rate under CRT, and therefore it was considered as heart rate-independent. Up-titration of beta-blocker after CRT may be necessary to induce optimal LVRR in some populations.