Abstract
A 39 year-old man was diagnosed at birth with dextrocardia, right single ventricle, transposition of the great arteries, and pulmonary valve stenosis. In 1982, he underwent a Blalock-Taussig shunt procedure in another hospital. Thereafter, invasive treatment was judged difficult and he was followed conservatively. In 2006, he presented to our hospital because of recurrent heart failure. In the same year, he underwent the Glenn operation, atrioventricular valve replacement, and DDD pacemaker implantation for complete atrioventricular block. After operation, he was treated with β blocker, amiodalone, and sotalol for frequent recurrence of heart failure, ventricular tachycardia(VT)and atrial tachycardia(AT). Despite the medications, heart failure and arrhythmia were notcontrolled, necessitating frequent admissions. We judged that ventricular dyssynchrony induced by right ventricular pacing was the cause of heart failure, and therefore upgraded his pacemaker to cardiac resynchronization therapy with defibrillator(CRT-D)in March, 2010. Since a transvenous approach is not possible after the Glenn operation, we performed a right thoracotomy and sutured the ventricular lead to the ventricle contralateral to the previous ventricular lead, placed a shock lead designed for transvenous maneuver subcutaneously, and implanted the CRT-D in the left abdomen. We considered using an epicardial patch but was concerned about diastolic dysfunction after patch placement in this patient with severe heart failure. Finally we decided to use a shock lead that was designed for transvenous maneuver. After implantation of the CRTD, the heart failure control was improved. However, for arrhythmia control, setting ofthe VT detection zone was difficult because the rates of slow VT and AT were very similar at around 110 bpm. We treated AT by AT/AF intervension. For VT, since hemodynamics was stabilized, we increased the number of antitachypacing to reduce shock. We report our experience of successful control of refractory VT and AT in a patient with single ventricle who had undergone the Glenn operation.