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Case Reports
. 2021 Jan;44(1):151-155.
doi: 10.1111/pace.14089. Epub 2020 Nov 8.

Pacemaker-mediated tachycardia in a dual-lead CRT-D: What is the mechanism?

Christopher Monkhouse  1 , Alex Cambridge  1 , Anthony W C Chow  2 , Jonathan Behar  3
Affiliations
Case Reports

Pacemaker-mediated tachycardia in a dual-lead CRT-D: What is the mechanism?

Christopher Monkhouse et al. Pacing Clin Electrophysiol. 2021 Jan.

Abstract

A 73-year-old gentleman with dilated cardiomyopathy, left bundle branch block and a left ventricular (LV) ejection fraction of 20% was implanted with two LV leads in a tri-ventricular cardiac resynchronisation therapy defibrillator (CRT-D) trial. As a part of the trial he was programmed with fusion-based CRT therapy with dual LV lead only pacing. The patient presented to local heart failure service 12 years after implant, after a positive response to CRT therapy, with increase in fatigue, shortness of breath and bilateral pitting oedema. The patient sent a remote monitoring transmission that suggested loss of capture on one of the LV leads. This coupled with atrial ectopics was producing a high burden of pacemaker-mediated tachycardia (PMT) that was not seen when both LV leads had been capturing. What is the mechanism for this? Dual LV-lead tri-ventricular leads have been shown to have variable improvements in CRT response but with an increased complexity of implant procedure. This is the first case report of PMT-induced heart failure exacerbation in a tri-ventricular device following loss of LV capture of one lead.

Keywords: TriVentricular; cardiac resynchronisation therapy; dual left ventricular lead; heart failure exacerbation; pacemaker-mediated tachycardia.

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References

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