Interruption of cardiac resynchronization therapy triggered by the automatic right-ventricular pacing threshold test
S Serge Barold1, Andreas Kucher2
1Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY, United States of America.
Journal of Electrocardiology
|June 2, 2019
Summary
Patients with heart failure and left bundle branch block experienced loss of cardiac resynchronization therapy. This occurred due to automatic pacing threshold tests interfering with biventricular pacing modes.
Area of Science:
- Cardiology
- Biomedical Engineering
- Electrophysiology
Background:
- Heart failure and left bundle branch block (LBBB) often necessitate cardiac resynchronization therapy (CRT).
- CRT devices, such as implantable defibrillators with CRT, aim to improve cardiac function by synchronizing ventricular contractions.
- Device-related complications can impact therapeutic efficacy.
Purpose of the Study:
- To report a specific, recurring loss of resynchronization in patients with CRT devices.
- To investigate the cause of desynchronization triggered by automatic device testing.
Main Methods:
- Case series reporting on three patients with heart failure and LBBB.
- Utilized BIOTRONIK implantable defibrillators with CRT.
- Observed device behavior during automatic right ventricular pacing threshold tests.
Main Results:
- Loss of resynchronization occurred consistently at night during automatic right ventricular pacing threshold tests.
- Desynchronization was triggered by the switch from test mode to permanent biventricular pacing.
- Reactivation of left ventricular (LV) control and LV sensed events inhibited LV pacing due to a realigned LV upper rate interval.
Conclusions:
- Automatic pacing threshold tests can unexpectedly disrupt CRT efficacy.
- Device programming and testing protocols require careful consideration to prevent loss of resynchronization.
- Understanding these interactions is crucial for optimizing CRT device management in heart failure patients.
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