OVERCOMING EXTREME MEDICAL–SURGICAL EVENTS, IN CARRIERS OF CRTD AND CCM. CLINICAL STABILIZATION

A 63–year–old male patient suffering from chronic dilated ischemic heart disease, with severe depression of contractility and estimated EF of 16%, carrier of CRT–D and CCM, in follow up at our center. Extreme events of medical/surgical interest have occurred in the last period: the patient underwent strangulated hernia surgery with ileostomy and subsequent stay in intensive care. Transferred spontaneously to cardiology where he was treated for heart failure also with norepinephrine and levosimendan. Once the CCM was reprogrammed with sensing recalibration and optimal delivery of therapy for 7 hours a day, interspersed with regular breaks, the patient showed a gradual improvement in vital parameters and in general clinical conditions, with more adequate blood pressure and diuresis regimes. The presence of the double device (CRT–D and CCM), together with medical therapy, allowed the patient‘s stabilization and clinical remission, with discharge and transfer to a cardiovascular rehabilitation center. The Cardiac Rhythm Management guaranteed by the CRTD, with optimization of medical therapy, together with the positive inotropic action of cardiac contractility modulation (CCM), allowed the patient to overcome high intensity surgical and medical events.