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Inappropriate Shock Therapy in a Heart Failure Defibrillator
Author(s) -
BETTS TIM R.,
ALLEN STUART,
ROBERTS PAUL R.,
MORGAN JOHN M.
Publication year - 2001
Publication title -
pacing and clinical electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.686
H-Index - 101
eISSN - 1540-8159
pISSN - 0147-8389
DOI - 10.1046/j.1460-9592.2001.00238.x
Subject(s) - medicine , cardiology , coronary sinus , shock (circulatory) , sinus rhythm , cardiac resynchronization therapy , left bundle branch block , heart failure , atrial fibrillation , ejection fraction
BETTS, T.R., et al. : Inappropriate Shock Therapy in a Heart Failure Defibrillator. A 63‐year‐old male with dilated cardiomyopathy underwent implantation of a “heart failure” defibrillator capable of biventricular pacing. He received an inappropriate shock 5 hours after the procedure. Stored electrograms revealed that during each sinus beat the ventricular channel recorded up to three separate events. These resulted from far‐field atrial sensing by the coronary venous lead, appropriate right ventricular sensing, then delayed left ventricular sensing (the result of left bundle branch block). As a consequence of far‐field left atrial sensing the two subsequent ventricular electrograms fell within the VF zone. Following an atrial premature beat, VF detection criteria were satisfied and shock therapy delivered. Although coronary venous lead repositioning eliminated far‐field atrial sensing, double counting of the widely split right and left ventricular electrograms still occurred during sinus rhythm. Shortening the programmed AV delay resulted in constant biventricular pacing with a single electrogram.