about 85 y old patient with bradycardia-tachycardia-syndrom and congestive heart failure. In context of asystolia we implantated a passagere VVI-pacemaker. In TEE we could see that there is a deterioration of cardiac wall movement with decrease of haemodynamic (decrease of blood pressure, decrease of pw-flow in LVOT) during right ventricular pacemaker-stimulation. In ECG during intrinsic heartbeat there is NO broad QRS-complex, the left ventricular ejection fraction is about 30-35%.
What can we do? Make it sence to implantate a CRT to avoid an asynchronuous stimulation with compromise of haemodynamic (NO broad QRS-complex < 100 msec; EF 30-35%!)?