Total epicardial biventricular pacing and defibrillation- A case report

A 66 year old lady with history of hypertension, diabetes presented with advanced HF. She was diagnosed to have carcinoma breast in the year 2006 and had undergone lumpectomy followed by chemotherapy and radiotherapy. She presented with severe LV dysfunction with LV ejection fraction(LVEF) of 35% (NYHA IV) with left bundle branch block (LBBB). Despite optimal medical therapy she was admitted twice for acute decompensated HF over one year period. Patient had diffuse lymphedema of right upper limb. In view of previous radiotherapy and lymphedema of right upper limb, left subclavian venogramwas performed which revealed long segment occlusion of left subclavian vein. Attempts at percutaneous recanalization of the left subclavian vein was unsuccessful. As the patient had chronic lymphedema of the right upper limb and chronic left subclavian vein obstruction which was not amenable for recanalization, we planned a complete epicardial implantation.