Optimal Dual-Chamber Pacing Therapy Improves Cardiac Function in a Patient with Complex Congenital Heart Disease and Bradyarrhythmias

A 38-year-old female with complex congenital heart disease was repeatedly hospitalized because of congestive heart failure with symptoms of New York Heart Association (NYHA) class IV. Her complex disease was composed of dextrocardia, single ventricle, transposition of the great arteries, atrial septal defect, pulmonary stenosis. She underwent Blalock-Taussing shunt and Waterston operations in her childhood. During follow-up in our outpatient clinic, 12-lead electrocardiograms showed advanced atrioventricular block and sinus bradycardia. These bradyarrhythmias affected progressively congestive heart failure. Accordingly, we performed the implantation of a dual-chamber pacemaker. At that time, we implanted two screw-in-leads intravenously on optimal sites of the atrium and ventricle without complications. The pacing therapy improved her heart failure with the reduction of NYHA class from III to IV and the decrement of serum brain natriuretic peptide level from 1,079 to 194 pg/mL. After the procedure, she had no hospitalization in the follow-up period of one year. Thus, pacing sites is extremely important when we perform pacemaker implantation in a patient with congestive heart failure and conduction disturbance, particularly in the setting of complex congenital heart disease.