Extended bipolar left ventricular pacing as a possible therapy for late electrical storm induced by cardiac resynchronization therapy

Although cardiac resynchronization therapy (CRT) has become a well-established treatment option for patients with drug-refractory severe systolic heart failure, there has been some evidence of adverse proarrhythmic events. We report a case of a patient with ischemic cardiomyopathy who underwent CRT with a defibrillator for primary prevention of sudden cardiac death. Two years after the implantation, the patient presented with electrical storm, which was completely terminated by modifying the left ventricular (LV) pacing configuration from true to extended bipolar LV pacing. We discuss the possible pathophysiologic mechanisms of this phenomenon through a brief review of the literature on CRT-induced proarrhythmia.