Inhibition and restoration of CRT pacing – What is the mechanism?

Ząbek, Andrzej; Małecka, Barbara; Dębski, Maciej; Boczar, Krzysztof; Holcman, Katarzyna; Ulman, Mateusz; Lelakowski, Jacek

doi:10.1016/j.jelectrocard.2018.01.003

Cited by 4 publications

(7 citation statements)

References 3 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…A more severe event is the induction of a longer desynchronization as shown in Figures B and A,B. The basic mechanism of desynchronization events is always similar: sensed LV events—for example, R‐wave double counting (Figure B) or premature beats (Figure A)—or intermittent capture losses (Figure B) trigger a LVURI (Biotronik) or a LVPP (Boston Scientific) which has not yet terminated when the subsequent LV‐pacing impulse should be delivered. This can lead to a repetitive sequence of LV‐sensed events resulting in LV‐pacing inhibition, resulting in permanent “lock‐in” of (intended) LV‐pacing impulses in the LVURI or LVPP, respectively.…”

Section: Clinical Considerations On LV Sensingmentioning

confidence: 89%

Left ventricular sensing in cardiac resynchronization devices—opportunities and pitfalls for device programming

Haeberlin

Ploux

Noël

et al. 2019

Cardiovasc electrophysiol

View full text Add to dashboard Cite

Introduction: Some cardiac resynchronization therapy (CRT) device manufacturers (Biotronik, Germany; Boston Scientific, United States) have implemented left ventricular (LV) sensing functionality to prevent pacing into the vulnerable phase.Physicians are only partially aware of programming pitfalls related to LV sensing and general programming advice is lacking. Methods and Results:We provide an illustrative case-series-based review of the variety of potential problems with LV sensing. LV sensing may inappropriately impair CRT delivery due to LV-sensing issues or improper device programming. This can cause beat-wise loss of resynchronization but also ongoing desynchronization. On the other hand, LV sensing provides additional diagnostic information, which may reveal intermittent problems of the LV lead such as capture loss.We summarize the available evidence to provide manufacturer-specific recommendations on device programming and troubleshooting for daily clinical practice.Conclusion: CRT devices with LV sensing may suffer from impaired resynchronization due to programming pitfalls. If LV sensing is active (nominal setting in Biotronik and Boston Scientific devices), careful lookout for related problems and resynchronization percentage is required. Optimization is mandatory and even deactivation of LV sensing may have to be considered. K E Y W O R D S cardiac resynchronization therapy, left ventricular lead, left ventricular sensing, lock-in

show abstract

Section: Clinical Considerations On LV Sensingmentioning

confidence: 89%

Left ventricular sensing in cardiac resynchronization devices—opportunities and pitfalls for device programming

Haeberlin

Ploux

Noël

et al. 2019

Cardiovasc electrophysiol

View full text Add to dashboard Cite

show abstract

“…The effect is directly related to the programmable LVURI (Biotronik) or the LV protection period (LVPP), (Boston Scientific), respectively. Originally intended to prevent pacing into the vulnerable phase, their potential negative effect on biventricular pacing has been reported for both manufacturers 10,11 . During the LVURI or LVPP, no pacing stimulus can be delivered via the LV pacing lead.…”

Section: Discussionmentioning

confidence: 99%

“…Originally intended to prevent pacing into the vulnerable phase, their potential negative effect on biventricular pacing has been reported for both manufacturers. 10,11 During the LVURI or LVPP, no pacing stimulus can be delivered via the LV pacing lead. An LVURI or LVPP can be initiated, for instance, by a ventricular premature beat and may trigger a subsequent lock-in phase as shown in Figure 2A Lock-in episodes will resolve after a certain time if the heart rate drops well below the maximum tracking rate.…”

Section: Sensing Capability-problems and Detrimental Effectsmentioning

confidence: 99%

See 1 more Smart Citation

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

Haeberlin

Ploux

Noël

et al. 2020

Pacing Clinical Electrophis

View full text Add to dashboard Cite

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.

show abstract

“…The recording of LV EGMs permits the diagnosis of device-induced arrhythmias, lead displacement with possible atrial far-field oversensing, electrical lead malfunction, and other abnormalities [12][13][14][15][16] ( Figure 1). Dissimilar rhythms can be recorded or documented by simultaneous recording of the EGM from both ventricles.…”

Section: Improved Diagnosis Of Arrhythmias and Lead Problemsmentioning

confidence: 99%

Left ventricular sensing by cardiac resynchronization devices

Barold

2019

Pacing Clinical Electrophis

View full text Add to dashboard Cite

Inhibition and restoration of CRT pacing – What is the mechanism?

Cited by 4 publications

References 3 publications

Left ventricular sensing in cardiac resynchronization devices—opportunities and pitfalls for device programming

Left ventricular sensing in cardiac resynchronization devices—opportunities and pitfalls for device programming

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

Left ventricular sensing by cardiac resynchronization devices

Contact Info

Product

Resources

About