Standard cardiac resynchronization therapy with a second right ventricular lead for severe right ventricular heart failure in 2 patients with repaired tetralogy of Fallot.

Tabled 1KEY TEACHING POINTS•Right ventricular (RV) mechanical dyssynchrony is proposed as a desirable therapeutic target for surgical repair of tetralogy of Fallot (rTOF) patients who have right bundle branch block or RV apical pacing complicated with RV heart failure. This condition can be visualized using transthoracic echocardiography or electroanatomic mapping, both of which reveal marked delay in the conduction of the RV free wall versus that of the septal wall.•Right-sided cardiac resynchronization therapy (CRT) by application of additional pacing at the RV free wall is effective for the treatment of RV heart failure that is refractory to medical therapy, in patients with rTOF with RV dyssynchrony.•To perform right-sided CRT using standard CRT equipment with only 3 ports, one can connect the RV apical lead to the RV port to stabilize ventricular sensing and connect the other 2 leads at the RV free wall and the LV-to-LV port via the Y-connector. Open table in a new tab