Two Implantable Devices for Cardiac Rhythm Management.

A 53-year-old, 104- kg, 165- cm woman with nonischemic cardiomyopathy with a reduced ejection fraction of 30%-to-35% secondary to cardiac sarcoidosis was admitted for decompensated heart failure. She previously had a single-chamber implantable cardioverter-defibrillator (ICD) placed via a left pectoral approach for the primary prevention of sudden cardiac death. Considering that the patient was on maximally tolerable guideline-directed medical therapy for heart failure with reduced ejection fraction, and was not a candidate for cardiac resynchronization therapy, the decision was made to augment her systolic function with a cardiac rhythm management device. After an uneventful implantation of her new device, a chest radiograph (Fig 1) and electrocardiogram showing changes (Fig 2, Fig 3) were obtained. What is the diagnosis? Fig 2Electrocardiogram with cardiac contractility modulation therapy OFF. View Large Image Figure Viewer Download Hi-res image Fig 3Electrocardiogram with cardiac contractility modulation therapy ON. View Large Image Figure Viewer Download Hi-res image