Trapped p waves causing loss of physiological left bundle branch pacing.
Daniel de Castro1, Cristina Aguilera-Agudo1, Víctor Castro-Urda1
1Arrhythmia Unit. Cardiology Department, University Hospital Puerta de Hierro, Madrid, Spain.
Pacing and Clinical Electrophysiology : PACE
|February 22, 2022
Summary
A pacemaker implantation after aortic valve replacement can lead to atrial undersensing, impairing ventricular resynchronization. Reprogramming the device and medication can resolve this complication.
Area of Science:
- Cardiology
- Cardiac Electrophysiology
- Interventional Cardiology
Background:
- Severe aortic stenosis necessitates intervention, often transcatheter aortic valve replacement (TAVR).
- Post-TAVR complications can include conduction abnormalities like left bundle branch block (LBBB).
- LBBB can necessitate permanent pacemaker implantation.
Observation:
- A 75-year-old woman developed LBBB and prolonged PR interval post-TAVR.
- A dual-chamber pacemaker was implanted targeting the left bundle branch area.
- Device interrogation revealed functional atrial undersensing.
Findings:
- Atrial undersensing led to loss of ventricular electric resynchronization.
- This condition compromised the effectiveness of the pacemaker in managing the conduction defect.
- The patient experienced suboptimal pacing due to the undersensing issue.
Implications:
- Recognizing atrial undersensing is crucial in patients with pacemakers post-TAVR.
- Device reprogramming and pharmacological adjustments offer a stepwise solution.
- Optimizing pacemaker function is essential for preventing heart failure exacerbation in this population.
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