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Case Reports
. 2018 Jan;23(1):e12473.
doi: 10.1111/anec.12473. Epub 2017 Jun 8.

Inhibition of left ventricular stimulation due to left ventricular lead failure and the left ventricular T-wave protection algorithm in patient with cardiac resynchronization therapy and pacemaker dependency

Andrzej Ząbek  1 , Barbara Małecka  1   2 , Maciej Dębski  1 , Krzysztof Boczar  1 , Jacek Lelakowski  1   2
Affiliations
Case Reports

Inhibition of left ventricular stimulation due to left ventricular lead failure and the left ventricular T-wave protection algorithm in patient with cardiac resynchronization therapy and pacemaker dependency

Andrzej Ząbek et al. Ann Noninvasive Electrocardiol. 2018 Jan.

Abstract

The electrocardiogram (ECG) interpretation in patients with cardiac resynchronization therapy (CRT) is often a perplexing problem. The difficulty in the device evaluation increases in the presence of unfamiliar timing cycles and a lead dysfunction. Authors describe a special function of a Biotronik CRT devices called the left ventricle T-wave protection (LVTP), and demonstrate its behavior in a patient with left ventricular (LV) lead failure. This report shows that sometimes it might be difficult to understand the loss of resynchronization in 12-lead ECG when LVTP feature is on, and a malfunction of left ventricular lead sensing occurs.

Keywords: ECG; cardiac resynchronization therapy; inhibition of LV stimulation; lead failure; left ventricular T-wave protection.

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Figures

Figure 1
Figure 1
ECG. Sinus rhythm at 62 bpm and biventricular pacing after a programmed sensed atrioventricular interval. Two patterns of paced QRS complexes with different width and morphology are visible. Narrower QRS complexes (*) resemble a typical uncomplicated biventricular pacing, whereas broader QRS complexes (**) resemble a typical mono‐chamber right ventricular apical stimulation. This ECG strip presumably depicts a malfunction of the left ventricular pacing
Figure 2
Figure 2
The intracardiac electrogram and electrocardiogram during pacemaker evaluation. The electrical noise originating from LV lead is visible in LV marker channel and LV electrogram. The inhibition of LV pacing is caused by LV lead oversensing and restarting of LVURI (x). Upper panel: A, RV, LV—atrial, right ventricular and left ventricular marker channel; bottom panel: A, RV, LV—atrial, right ventricular and left ventricular electrogram. AS, atrial sense; VRp, right ventricular pacing; LVp, left ventricular pacing; RVs, right ventricular sensing; LVs, left ventricular sensing; LVrs, left ventricular sensing in left ventricular refractory period; the red color shows LVURI timing cycles during which the LV stimulation was inhibited. See text for details
See this image and copyright information in PMC

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