Arrhythmias of Biventricular Pacemakers and Implantable Cardioverter Defibrillators

Barold, S. Serge; Garrigue, Stéphane; Israel, Carsten W.; Gallardo, Ignacio; Clémenty, Jacques

doi:10.1002/9780470988404.ch9

Cited by 3 publications

(9 citation statements)

References 19 publications

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“…In patients with normal or near normal sinus node function and AV conduction and a relatively short PVARP, a pacemaker Weckenbach upper rate response takes the form of a repetitive pre-empted process which consists of an attempted Wenckebach upper rate response with each cycle, associated with continual partial or incomplete extension of the programmed AV interval 12,43 (Figs. 10 and 11).…”

Section: Pre-empted Wenckebach Upper Rate Responsementioning

confidence: 99%

“…The common sensing channel predisposes the pacemaker to double sensing of the ventricular electrogram 12,44 (Table 4). Such systems (using a conventional DDD pacemaker and a Y-adapter) are still being implanted in various countries because of cost considerations.…”

Section: Simultaneous Sensing Of the Ventricular Electrogram From Botmentioning

confidence: 99%

“…11,12,[52][53][54][55][56] In the first-generation devices with a common sensing channel, far-field atrial sensing by the ventricular channel inhibits biventricular pacing and induces the emergence of spontaneous AV conduction (Table 5). 11,12,[52][53][54][55][56] In the first-generation devices with a common sensing channel, far-field atrial sensing by the ventricular channel inhibits biventricular pacing and induces the emergence of spontaneous AV conduction (Table 5).…”

Section: Far-field Sensing Of Atrial Depolarization Causing Double Anmentioning

confidence: 99%

“…12,50 One commercially available first-generation Guidant biventricular ICD (Contak CD) system used a conventional dual cathodal system and sensed simultaneously from the RV and LV causing double counting in about 7% of cases. 12,50 One commercially available first-generation Guidant biventricular ICD (Contak CD) system used a conventional dual cathodal system and sensed simultaneously from the RV and LV causing double counting in about 7% of cases.…”

Section: Devices Susceptible To Double Countingmentioning

confidence: 99%

“…The advent of multisite pacing for the treatment of congestive heart failure (CHF) has added a new dimension to the electrocardiographic evaluation of pacemaker function. [1][2][3][4][5][6][7][8][9][10][11][12][13] For many years,…”

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confidence: 99%

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Electrocardiographic Follow‐Up of Biventricular Pacemakers

Barold¹,

Herweg²,

Giudici³

2005

Noninvasive Electrocardiol

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Multisite pacing for the treatment of heart failure has added a new dimension to the electrocardiographic evaluation of device function. During left ventricular (LV) pacing from the appropriate site in the coronary venous system, a correctly positioned lead V1 registers a right bundle branch block pattern with few exceptions. During biventricular stimulation associated with right ventricular (RV) apical pacing, the QRS is often positive in lead V1. The frontal plane QRS axis is usually in the right superior quadrant and occasionally in the left superior quadrant. Barring incorrect placement of lead V1 (too high on the chest), lack of LV capture, LV lead displacement or marked latency (exit block or delay from the stimulation site), ventricular fusion with the spontaneous QRS complex, a negative QRS complex in lead V1 during biventricular pacing involving the RV apex probably reflects different activation of an heterogeneous biventricular substrate (ischemia, scar, His-Purkinje participation in view of the varying patterns of LV activation in spontaneous left bundle branch block) and does not necessarily indicate a poor (electrical or mechanical) contribution from LV stimulation. In this situation, it is imperative to rule out the presence of coronary venous pacing via the middle cardiac vein or even unintended placement of two leads in the RV. During biventricular pacing with the RV lead in the outflow tract, the paced QRS in lead V1 is often negative and the frontal plane paced QRS axis is often directed to the right inferior quadrant (right axis deviation). In patients with sinus rhythm and a relatively short PR interval, ventricular fusion with competing native conduction during biventricular pacing may cause misinterpretation of the ECG because narrowing of the paced QRS complex simulates appropriate biventricular capture. This represents a common pitfall in device follow-up. Elimination of ventricular fusion by shortening the AV delay, is often associated with clinical improvement. Anodal stimulation may complicate threshold testing and should not be misinterpreted as pacemaker malfunction. One must be cognizant of the various disturbances that can disrupt 1:1 atrial tracking and cause loss of ventricular resynchronization. (1) Upper rate response. The upper rate response of biventricular pacemakers differs from the traditional Wenckebach upper rate response of conventional antibradycardia pacemakers because heart failure patients generally do not have sinus bradycardia or AV junctional conduction delay. The programmed upper rate should be sufficiently fast to avoid loss of resynchronization in situations associated with sinus tachycardia. (2) Below the programmed upper rate. This may be caused by a variety of events (especially ventricular premature complexes and favored by the presence of first-degree AV block) that alter the timing of sensed and paced events. In such cases, atrial events become trapped into the postventricular atrial refractory period at atrial rates below the programmed upper rate in the...

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Section: Pre-empted Wenckebach Upper Rate Responsementioning

confidence: 99%

Section: Simultaneous Sensing Of the Ventricular Electrogram From Botmentioning

confidence: 99%