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Case Reports
. 2024 Sep 7;10(12):890-895.
doi: 10.1016/j.hrcr.2024.08.023. eCollection 2024 Dec.

Misdiagnosis of pseudo-ineffective biventricular pacing using the automatic effective cardiac resynchronization therapy algorithm

Masaki Taniguchi  1 , Takafumi Oka  2 , Tomoaki Nakano  2 , Kentaro Ozu  2 , Takayuki Sekihara  2 , Yasushi Sakata  2
Affiliations
Case Reports

Misdiagnosis of pseudo-ineffective biventricular pacing using the automatic effective cardiac resynchronization therapy algorithm

Masaki Taniguchi et al. HeartRhythm Case Rep. .
No abstract available

Keywords: Algorithm; Biventricular pacing; Cardiac resynchronization therapy; Congestive heart failure; EffectvCRT; Misdiagnosis.

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Conflict of interest statement

Takafumi Oka received remuneration for lectures from Medtronic Japan and Yasushi Sakata received a scholarship from Medtronic Japan; the rest of the authors have no conflicts of interest.

Figures

Figure 1
Figure 1
A: Twelve-lead electrocardiogram of biventricular pacing (BiVp) at the routine visit immediately before EffectivCRT (Medtronic, Minneapolis, MN) was turned on. B: Trends in the percentage of effective BiVp (%EBiVp) and ventricular pacing (%Vp) after EffectivCRT was turned on. C: Trends in the pacing threshold of left ventricular pacing (LVp) after EffectivCRT was turned on. D: Trends in LV lead impedance after EffectivCRT was turned on. E: Intracardiac electrogram when the %EBiVp was approximately 30% just after EffectivCRT was turned on. ms = milliseconds; PW = pulse width.
Figure 2
Figure 2
A: A 12-lead electrocardiogram (ECG) showing the absence of own beat under biventricular pacing (BiVp) off. B: Electrogram (EGM) during manually created loss of capture. C: EGMs under left ventricular pacing (LVp) only, BiVp (VV delay: left ventricle→right ventricle 60–0 milliseconds and RV→LV 0–80 milliseconds), and right ventricular pacing (RVp) only. Red arrows indicate positive wave preceding negative wave in unipolar LV. LV = left ventricle; ms = milliseconds; RV = right ventricle.
Figure 3
Figure 3
A: Conduction latency under right ventricular pacing (RVp) only (left), left ventricular pacing (LVp) only (middle), and biventricular pacing (BiVp) (right). Amplitude: 0.25 mV/10 mm. B: EffectivCRT algorithm. The 4 criteria (1–4) must be fulfilled for the diagnosis of effective BiVp. Criterion 4 (|Max.|+|Min.| ≥1.6 mV) was the key criterion in this case. C: Electrogram (EGM) (upper) immediately after turning on EffectivCRT (left) and at the revisit (right). The manually measured sums of the negative and positive peaks (|Max. |+|Min.|) are shown above the EGMs. Chest radiograph (lower panel). The cardiothoracic ratio (CTR) and serum N-terminal pro–B-type natriuretic peptide (NT-proBNP) levels are also shown. Max. = maximum; Min. = minimum; msec = milliseconds.
Supplemental Figure 1
Supplemental Figure 1
Fluoroscopic image of the lead positions.
Supplemental Figure 2
Supplemental Figure 2
Electrogram under biventricular pacing (BiVp) rates (80–30 ppm). ECG = electrocardiogram; LV = left ventricular; RV = right ventricular.
See this image and copyright information in PMC

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