Left ventricular sensing in cardiac resynchronization devices-opportunities and pitfalls for device programming.
Publisher DOI
PubMed ID
31231884
Abstract
INTRODUCTION
Some cardiac resynchronization therapy (CRT) device manufacturers (Biotronik, Germany; Boston Scientific, United States) have implemented left ventricular (LV) sensing functionality to prevent pacing into the vulnerable phase. Physicians are only partially aware of programming pitfalls related to LV sensing and general programming advice is lacking.
METHODS AND RESULTS
We provide an illustrative case-series-based review of the variety of potential problems with LV sensing. LV sensing may inappropriately impair CRT delivery due to LV-sensing issues or improper device programming. This can cause beat-wise loss of resynchronization but also ongoing desynchronization. On the other hand, LV sensing provides additional diagnostic information, which may reveal intermittent problems of the LV lead such as capture loss. We summarize the available evidence to provide manufacturer-specific recommendations on device programming and troubleshooting for daily clinical practice.
CONCLUSION
CRT devices with LV sensing may suffer from impaired resynchronization due to programming pitfalls. If LV sensing is active (nominal setting in Biotronik and Boston Scientific devices), careful lookout for related problems and resynchronization percentage is required. Optimization is mandatory and even deactivation of LV sensing may have to be considered.
Some cardiac resynchronization therapy (CRT) device manufacturers (Biotronik, Germany; Boston Scientific, United States) have implemented left ventricular (LV) sensing functionality to prevent pacing into the vulnerable phase. Physicians are only partially aware of programming pitfalls related to LV sensing and general programming advice is lacking.
METHODS AND RESULTS
We provide an illustrative case-series-based review of the variety of potential problems with LV sensing. LV sensing may inappropriately impair CRT delivery due to LV-sensing issues or improper device programming. This can cause beat-wise loss of resynchronization but also ongoing desynchronization. On the other hand, LV sensing provides additional diagnostic information, which may reveal intermittent problems of the LV lead such as capture loss. We summarize the available evidence to provide manufacturer-specific recommendations on device programming and troubleshooting for daily clinical practice.
CONCLUSION
CRT devices with LV sensing may suffer from impaired resynchronization due to programming pitfalls. If LV sensing is active (nominal setting in Biotronik and Boston Scientific devices), careful lookout for related problems and resynchronization percentage is required. Optimization is mandatory and even deactivation of LV sensing may have to be considered.
Date Issued
2019-08
Publication Type
Article
Subjects
cardiac resynchronization therapy left ventricular lead left ventricular sensing lock-in
Language(s)
en
Author(s)
Ploux, Sylvain | |
Noel, Antoine | |
Chauvel, Rémi | |
Welte, Nicolas | |
Marchand, Hugo | |
Haissaguerre, Michel | |
Ritter, Philippe | |
Bordachar, Pierre |
Additional Credits
Journal
Journal of cardiovascular electrophysiology
Publisher
Wiley-Blackwell
ISSN
1045-3873
Access(Rights)
restricted