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Worsening Cardiomyopathy Despite Biventricular Pacing

Educational Objective
Based on this clinical scenario and the accompanying image, understand how to arrive at a correct diagnosis.
1 Credit CME

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Article Information

Corresponding Author: Matthew C. Hyman, MD, PhD, Division of Cardiovascular Medicine, Electrophysiology Section, Hospital of the University of Pennsylvania, 3400 Spruce St, 9 Gates Pavilion, Philadelphia, PA 19104 (Matthew.Hyman@pennmedicine.upenn.edu).

Published Online: August 11, 2021. doi:10.1001/jamacardio.2021.2755

Conflict of Interest Disclosures: None reported.

Funding/Support: This work was supported by a grant from the Fondation Leducq (TNE FANTASY 19CV03).

Role of the Funder/Sponsor: The funder had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Additional Contributions: We thank the patient’s daughter for granting permission to publish this information on the patient’s behalf.

References
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Sweeney  MO .  Troubleshooting of Biventricular Devices: Clinical Cardiac Pacing, Defibrillation and Resynchronization Therapy. Elsevier; 2011:911-986. doi:10.1016/B978-1-4377-1616-0.00031-X
2.
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3.
van Gelder  BM , Bracke  FA , Pilmeyer  A , Meijer  A .  Triple-site ventricular pacing in a biventricular pacing system.   Pacing Clin Electrophysiol. 2001;24(7):1165-1167. doi:10.1046/j.1460-9592.2001.01165.xPubMedGoogle ScholarCrossref
4.
Abu Sham’a  R , Kuperstein  R , Barsheshet  A ,  et al.  The effects of anodal stimulation on electrocardiogram, left ventricular dyssynchrony, and acute haemodynamics in patients with biventricular pacemakers.   Europace. 2011;13(7):997-1003. doi:10.1093/europace/eur076PubMedGoogle ScholarCrossref
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Dendy  KF , Powell  BD , Cha  Y-M ,  et al.  Anodal stimulation: an underrecognized cause of nonresponders to cardiac resynchronization therapy.   Indian Pacing Electrophysiol J. 2011;11(3):64-72.PubMedGoogle Scholar
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Thibault  B , Roy  D , Guerra  PG ,  et al.  Anodal right ventricular capture during left ventricular stimulation in CRT-implantable cardioverter defibrillators.   Pacing Clin Electrophysiol. 2005;28(7):613-619. doi:10.1111/j.1540-8159.2005.00158.xPubMedGoogle ScholarCrossref
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