Imre Hunyor, MBBS, DPhil, Hany S. Abed, MBBS, PhD, Raymond W

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Presentation transcript:

Intermittent failure of pacing output caused by algorithm to prevent T-wave oversensing Imre Hunyor, MBBS, DPhil, Hany S. Abed, MBBS, PhD, Raymond W. Sy, MBBS, PhD, Emily C. Hodkinson, MB, ChB, Peter Santucci, MD, Mark A. McGuire, MBBS, PhD HeartRhythm Case Reports Volume 2, Issue 4, Pages 286-289 (July 2016) DOI: 10.1016/j.hrcr.2016.01.003 Copyright © 2016 Heart Rhythm Society Terms and Conditions

Figure 1 Representative cardiac telemetry recordings show failure of pacing (arrows) the day after device implantation in A: case 1 and B: case 2. C: A posteroanterior chest x-ray showing the 3 leads in situ at the locations documented at implant for case 2. HeartRhythm Case Reports 2016 2, 286-289DOI: (10.1016/j.hrcr.2016.01.003) Copyright © 2016 Heart Rhythm Society Terms and Conditions

Figure 2 Intracardiac electrograms from patient in case 1. Shown from top to bottom: lead II AutoGain; marker channel; atrial bipolar electrogram; right ventricular near field; and left ventricular distal tip 1 to mid-pole 2. Sweep speed 25 mm/s. A: Low-frequency attenuation (LFA) filter ON at nominal sensitivity 0.5 mV with normal quiet breathing. B: LFA ON at nominal sensitivity 0.5 mV with deep inspiration maneuvers. High-frequency, low-amplitude “noise” seen on near-field electrogram channel with associated inhibition of pacing (arrow). C: LFA filter ON at a sensitivity of 1.0 mV (least sensitive) with deep breathing. Noise is seen again on the near field (arrow); however, owing to the low sensitivity setting on the right ventricular near field channel (1.0 mV), no oversensing or pacing inhibition is observed. D: LFA filter OFF at nominal sensitivity 0.3 mV and deep inspiration. Diaphragmatic myopotential noise (arrowhead) is not amplified, owing to absence of LFA filter algorithm operation; therefore, no oversensing is observed. HeartRhythm Case Reports 2016 2, 286-289DOI: (10.1016/j.hrcr.2016.01.003) Copyright © 2016 Heart Rhythm Society Terms and Conditions

Figure 3 Intracardiac electrograms from patient in case 2. Electrogram set-up and sweep speed is as described in Figure 2. A: Low-frequency attenuation (LFA) filter ON at nominal sensitivity 0.5 mV with normal quiet breathing. B: LFA filter ON at nominal sensitivity 0.5 mV with deep inspiration maneuvers. High-frequency, low-amplitude “noise” is seen on the right ventricular near-field electrogram channel with associated inhibition of pacing (arrow). C: LFA filter ON at a sensitivity 1.0 mV (least sensitive) with deep breathing. Noise is seen on the near field (arrow); however, owing to the low sensitivity setting on the right ventricular near-field channel (1.0 mV), no oversensing or pacing inhibition is observed. D: LFA filter OFF at nominal sensitivity 0.3 mV and deep inspiration. Diaphragmatic myopotential noise (arrowhead) is not amplified, owing to absence of LFA filter algorithm operation; therefore, no oversensing is observed. HeartRhythm Case Reports 2016 2, 286-289DOI: (10.1016/j.hrcr.2016.01.003) Copyright © 2016 Heart Rhythm Society Terms and Conditions