2:1 Atrioventricular Block After Upgrade From DDD to CRT-D
Jingfang Cui1, Ji Li1, Yongjia Li1
1Department of Cardiology, Bethune International Peace Hospital, Shijiazhuang, China.
Background:
A high burden of right ventricular pacing predisposes patients to pacing-induced cardiomyopathy. Cardiac resynchronization therapy with defibrillator (CRT-D) effectively addresses this by delivering biventricular pacing, and a high rate of such pacing is essential for optimal clinical response.
Case Summary:
We present a patient with high-grade atrioventricular block who developed 2:1 ventricular pacing after upgrade to CRT-D given pacing-induced cardiomyopathy. The condition was ultimately confirmed to be due to intermittent T-wave oversensing. We successfully restored atrioventricular sequential pacing by adjusting ventricular sensing sensitivity and administering antiarrhythmic medication.
Discussion:
CRT-D serves as a crucial therapeutic approach for cardiac insufficiency; however, a low biventricular pacing percentage cannot effectively improve cardiac function. Therefore, timely detection and appropriate intervention are essential to ensure adequate biventricular pacing.
Take-Home Messages:
It is important to perform optimal postprocedural management of CRT-D patients to ensure biventricular pacing. Relevant clinical data should be provided when troubleshooting T-wave oversensing.
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