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Bilateral Venous Access for Cardiac Resynchronization Therapy in a Hemodialysis Patient With Cabozantinib-associated Heart Failure

AMANE OTOI, AKINORI HIGAKI, NORIYOSHI MIURA, KEISHO KUROKAWA, KOHEI YOSHIMOTO, TOMOAKI NISHIKAWA, RIKAKO HORIE, ARISA ABE, YASUHISA NAKAO, TOMOKI FUJISAWA, SHIGEHIRO MIYAZAKI, YUSUKE AKAZAWA, TORU MIYOSHI, HIROSHI KAWAKAMI, HARUHIKO HIGASHI, SHUNSUKE TAMAKI, KAZUHISA NISHIMURA, KATSUJI INOUE, SHUNTARO IKEDA and OSAMU YAMAGUCHI
In Vivo May 2025, 39 (3) 1719-1723; DOI: https://doi.org/10.21873/invivo.13973

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  • Figure 1.
    Figure 1.

    Electrocardiogram (ECG) before and after cardiac resynchronization therapy (CRT). A) ECG showing complete left bundle branch block (CLBBB) with a QRS duration of 154 ms at the initial cardiology visit. B) ECG taken at the follow-up visit after CRT, showing a reduced QRS duration of 124 ms. Left ventricular pacing, rather than biventricular pacing, was employed based on echocardiography-guided optimization.

  • Figure 2.
    Figure 2.

    Chest X-rays before and after cardiac resynchronization therapy (CRT). A) Chest radiograph from the initial cardiology visit, demonstrating cardiomegaly with a cardiothoracic ratio of 57.7%. B) Follow-up chest radiograph after CRT, showing a reduction in the cardiothoracic ratio to 54.6%. The CRT generator is implanted in the right chest, with the left ventricular lead positioned via the left subclavian vein (arrow).

  • Figure 3.
    Figure 3.

    Apical four chamber views of echocardiography before and after cardiac resynchronization therapy (CRT). A) Transthoracic echocardiography (TTE) at the initial cardiology visit, showing a dilated left ventricle (left ventricular end-diastolic diameter [LVEDD]: 61.9 mm) and a reduced ejection fraction (EF) of 34%, with apical shuffling and a septal flash. B) TTE at the follow-up visit after CRT, demonstrating reverse remodeling with an improved EF of 53% and a reduced LVEDD of 57.3 mm.

  • Figure 4.
    Figure 4.

    Bilateral venous approach for cardiac resynchronization therapy (CRT). A) A tunneled lead from the contralateral vasculature to the ipsilateral pulse generator. B) Final view of CRT implantation in the right anterior oblique (RAO) projection. C) Left anterior oblique (LAO) view following CRT completion.

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Bilateral Venous Access for Cardiac Resynchronization Therapy in a Hemodialysis Patient With Cabozantinib-associated Heart Failure
AMANE OTOI, AKINORI HIGAKI, NORIYOSHI MIURA, KEISHO KUROKAWA, KOHEI YOSHIMOTO, TOMOAKI NISHIKAWA, RIKAKO HORIE, ARISA ABE, YASUHISA NAKAO, TOMOKI FUJISAWA, SHIGEHIRO MIYAZAKI, YUSUKE AKAZAWA, TORU MIYOSHI, HIROSHI KAWAKAMI, HARUHIKO HIGASHI, SHUNSUKE TAMAKI, KAZUHISA NISHIMURA, KATSUJI INOUE, SHUNTARO IKEDA, OSAMU YAMAGUCHI
In Vivo May 2025, 39 (3) 1719-1723; DOI: 10.21873/invivo.13973
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