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Left ventricular sensing in cardiac resynchronization devices-opportunities and pitfalls for device programming.
Andreas Haeberlin1,2,3, Sylvain Ploux1,2, Antoine Noel1,2
1Dept. of Cardiology, Cardiothoracic Unit, Bordeaux University Hospital (CHU), Pessac, France.
Journal of Cardiovascular Electrophysiology
|June 25, 2019
Summary
Physicians need awareness of left ventricular (LV) sensing programming pitfalls in cardiac resynchronization therapy (CRT) devices. Proper programming and troubleshooting are crucial to avoid impaired resynchronization and ensure optimal patient outcomes.
Area of Science:
- Cardiology
- Biomedical Engineering
Background:
- Cardiac resynchronization therapy (CRT) utilizes left ventricular (LV) sensing to prevent pacing during vulnerable phases.
- Awareness of LV sensing programming pitfalls among physicians is limited, with a lack of general programming guidance.
Purpose of the Study:
- To review potential problems associated with LV sensing in CRT devices.
- To provide manufacturer-specific recommendations for device programming and troubleshooting.
Main Methods:
- Case-series-based review of LV sensing issues.
- Analysis of potential impacts on CRT delivery and resynchronization.
- Evidence summary for clinical practice guidelines.
Main Results:
- LV sensing can inappropriately impair CRT delivery, causing beat-wise or ongoing desynchronization.
- LV sensing offers diagnostic insights into LV lead issues like capture loss.
- Programming pitfalls are a significant concern with active LV sensing.
Conclusions:
- CRT devices with LV sensing are susceptible to impaired resynchronization due to programming errors.
- Active LV sensing (default in Biotronik and Boston Scientific devices) requires vigilant monitoring of resynchronization percentage.
- Optimization of LV sensing programming is mandatory; deactivation may be necessary in some cases.
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