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Causes of impaired biventricular pacing in cardiac resynchronization devices with left ventricular sensing
Author(s) -
Haeberlin Andreas,
Ploux Sylvain,
Noel Antoine,
Chauvel Rémi,
Welte Nicolas,
Marchand Hugo,
Haïssaguerre Michel,
Ritter Philippe,
Eschalier Romain,
Bordachar Pierre
Publication year - 2020
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 - 10.1111/pace.13883
Subject(s) - medicine , cardiac resynchronization therapy , cardiology , heart failure , cardiac pacing , ejection fraction
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.