Far‐Field Atrial Sensing by the Left Ventricular Channel of a Biventricular Device

Barold, S. Serge; Kucher, Andreas

doi:10.1111/pace.12482

Cited by 7 publications

(8 citation statements)

References 11 publications

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“…16 LV electrodes for sensing may increase the likelihood of inadvertent oversensing of p-waves. 17,18 The most common consequence of temporary LV pacing inhibition was LV upper rate lock-in, which accounted for the majority of all LV pacing interruptions that we observed. It is of particular importance as it may lead to sustained desynchronization.…”

Section: Sensing Capability-problems and Detrimental Effectsmentioning

confidence: 89%

“…This may be explained by a higher susceptibility to pectoral muscle artifacts (in particular in physically active patients), FFPWO, and noise due to the higher required sensitivity in the LV sensing channel. Similarly, relatively basal implantation of the LV lead or the use of the proximal LV electrodes for sensing may increase the likelihood of inadvertent oversensing of p‐waves 17,18 …”

Section: Discussionmentioning

confidence: 99%

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Causes of impaired biventricular pacing in cardiac resynchronization devices with left ventricular sensing

Haeberlin

Ploux

Noël

et al. 2020

Pacing Clinical Electrophis

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Background Loss of biventricular stimulation can result in nonresponse to cardiac resynchronization therapy (CRT). Problems associated with the left ventricular (LV) lead and LV sensing can be challenging to detect and their incidence is unclear. The purpose of this study was to investigate mechanisms of loss of biventricular pacing due to LV lead‐ and LV sensing‐associated problems. Methods In this bicentric study, CRT patients were surveilled using a novel remote monitoring algorithm from Biotronik (Germany) that registers LV electrograms (EGMs) during intermittent loss of resynchronization. The episodes were analyzed to assess the mechanisms of resynchronization interruptions. Results We analyzed 582 EGMs from 61 patients. During a median follow‐up of 6 months, 59% of the patients had such episodes. The majority of the episodes (61%) were related to inappropriate inhibition of LV pacing, mostly due to upper rate lock‐in caused by LV sensing (58%). In contrast, 8% of episodes showed intermittent loss of LV capture, which was identified thanks to LV sensing. The remaining 31% of episodes were due to physiological reasons for resynchronization interruptions (eg, supraventricular tachycardia [18%], premature beats [8%], and others [5%]). Patients with CRT interruption episodes had lower resynchronization rates (median: 98.5% vs 100%, P = .044). Conclusions Inadequate programming (active LV sensing with T‐wave protection) is the main cause of impaired resynchronization in devices with LV sensing. In general, we recommend the deactivation of the LV T‐wave protection function.

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Section: Sensing Capability-problems and Detrimental Effectsmentioning

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Causes of impaired biventricular pacing in cardiac resynchronization devices with left ventricular sensing

Haeberlin

Ploux

Noël

et al. 2020

Pacing Clinical Electrophis

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“…Displacement of an LV lead toward the coronary sinus places it where left atrial activity may be sensed. There are no reports of far‐field atrial oversensing during sinus rhythm by a correctly positioned LV lead for CRT . Consequently, far‐field atrial sensing by an LV lead strongly suggests lead displacement toward the AV groove.…”

Section: Left Ventricular Sensingmentioning

confidence: 99%

Triple atrial sensing during cardiac resynchronization

Barold

Kucher

Halfenberg

2020

Journal of Arrhythmia

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cardiac resynchronization, implantable cardioverter-defibrillator, pacemaker, Twiddler syndrome, ventricular tachycardia A 77-year-old man received a transvenous cardiac resynchronization device with cardioverter-defibrillation capability (Lumax 640 HF-T; BIOTRONIK). Ten months later, he presented with a shock. Figure 1 shows the data retrieved by interrogating the device.What is the interpretation of the recording and the mechanism of the shock? Why is atrial sensing present in all three channels?The device parameters and marker annotations were as follows: VT1 = programmed ventricular tachycardia interval for antitachycardia pacing (first therapy) 350 ms (170 bpm) and VF = ventricular fibrillation 270 ms (220 bpm). Therapy for VT1 was initiated with antitachycardia pacing (ATP); four bursts first followed by four ATP ramps and then a 40 J shock if ATP was unsuccessful.In Figure 1, the marker channels are on top and the electrograms are below. A = atrium, RV = right ventricle, and LV = left ventricle.There is sinus rhythm at about 115 beats per minute and the third atrial beat is unsensed. There is also atrial undersensing before the shock on the right side of the tracing. Intermittent atrial undersensing is because of the atrial lead displacement. The right ventricular lead shows a double waveform consisting of the atrial and ventricular electrograms. On the right, there is a single episode of Mobitz type II AV block demonstrated by the loss of a ventricular electrogram. The right ventricular lead was displaced to the right atrium where the near-field atrial electrograms and the far-field ventricular electrograms are recorded. The right ventricular channel senses both the atrial and ventricular electrograms resulting in short ventricular intervals alternating with long ones. The short intervals (173-188 ms), depicted by VF markers, correspond to the PR interval. The long intervals, depicted by VT1 markers, measure less than 350 ms (the VT1 interval) except for a longer interval after the non-conducted atrial beat. The device delivers a shock at the end of the tracing as shown by the large baseline deflection. Note that all three leads demonstrate atrial sensing. | LEF T VENTRICUL AR S EN S INGSome implantable devices for cardiac resynchronization therapy (CRT) with cardioverter-defibrillator capability, as the one in this report, can sense LV activity. 1 LV sensing functionality was designed primarily to prevent pacing into the vulnerable period of the LV myocardium. Displacement of an LV lead toward the coronary sinus places it where left atrial activity may be sensed. There are no reports of far-field atrial oversensing during sinus rhythm by a correctly positioned LV lead for CRT. 2 Consequently, far-field atrial sensing by an LV lead strongly suggests lead displacement toward the AV groove. Although far-field atrial sensing did not involve the delivery of therapy it contributes to the description of triple atrial sensing. | T WIDDLER SYNDROMEFar-field atrial oversensing in the right and left ventricular lea...

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“…Far‐field atrial sensing by the LV lead is almost invariably caused by displacement or malposition of the LV lead toward the coronary sinus from where left atrial activity may be sensed (Figure ) . Far‐field sensing of atrial activity by the LV channel does not affect RV timing cycles but it must be corrected because it reduces or eliminates therapeutic biventricular pacing for heart failure.…”

Section: Disadvantages Of Left Ventricular Sensingmentioning

confidence: 99%

“…Same format as given in Figure (Adapted from Ref. ). As = atrial sensed; AV = atrioventricular; CRT = cardiac resynchronization therapy; FFA = far‐field atrial; LV = left ventricular; LVp = LV paced; LVrs = LV refractory sensed; LVs = LV sensed; LVURI = LV upper rate interval; RVp = right ventricular paced…”

Section: Disadvantages Of Left Ventricular Sensingmentioning

confidence: 99%