A case of diaphragmatic pacing with cardiac resynchronization therapy

Cardiac resynchronization therapy (CRT) is now an accepted treatment for heart failure [McAlister et al. in Cardiac resynchronization therapy for patients with left ventricular systolic dysfunction: a systematic review. JAMA 2007;297:2502-14.]. In addition to the complications associated with standard pacemaker implants, CRT procedures have their own additional complications such as coronary sinus dissection, diaphragmatic stimulation, and longer implant times. We present a case of CRT implantation which illustrates these problems because of an unusual complication.