Affiliation:
1. FSBI Federal Center for High Medical Technologies of Healthcare Ministry of Russia
Abstract
The article describes a clinical case of a patient with a previously implanted cardiac resynchronization therapy with defibrillator function (CRT-D). For a long time, the patient was observed in the implanting clinic and the data was also transmitted via remote monitoring. The developing acute myocardial infarction in the right coronary artery caused a change in the parameter of the amplitude of the spontaneous R-wave in the patient. Subsequent ventricular fibrillation (VF) due to stent thrombosis was undetected by the defibrillator and resulted in no detection and cessation of VF, despite the implanted CRT-D. Changing the programming parameters did not affect the possibility of detecting a recurrent VF. The VF that occurred twice was stopped by the first discharge of the external device. In view of the remaining low hyposensing, a decision was made to reimplant the detecting part of the right ventricular electrode, after which defibrillation test proved to be effective for termination induced VF. We believe that at critically low parameters of spontaneous R-wave hyposensing, for the device to detect low-amplitude ventricular arrhythmias, programming the parameters does not solve the problem of hyposensing. Current myocardial infarction as the cause of hyposensing may require active surgical tactics replacement of the pacing and sensing electrode, in cases where the device connector allows this.
Publisher
Institute of Cardio Technics - INCART
Subject
Pharmacology (medical),Cardiology and Cardiovascular Medicine,Emergency Medicine
Reference15 articles.
1. Prystowsky EN, Nisam S. Prophylactic implantable cardioverter defibrillator trials: MUSTT, MADIT, and beyond. Multicenter Unsustained Tachycardia Trial. Multicenter Automatic Defibrillator Implantation Trial. The American Journal of Cardiology. 2000;86(11): 1214-1215, A5. https://doi.org/10.1016/s0002-9149(00)01205-4.
2. Bardy GH, Lee KL, Mark DB. et al. Amiodarone or an implantable cardioverter-defibrillator for congestive heart failure. The New England Journal of Medicine. 2005;352(3): 225-237. https://doi.org/10.1056/NEJ-Moa043399.
3. Chang PC, Chen WT, Wo HT. et al. Long-Term Survival of Multicenter Automatic Defibrillator Implantation Trial (MADIT) II-Eligible Patients in Taiwan. Acta Cardiologica Sinica. 2014;30(3): 229-235.
4. Reiter MJ, Mann DE. Sensing and tachyarrhythmia detection problems in implantable cardioverter defibrillators. Journal of Cardiovascular Electrophysiology. 1996;7(6): 542-558. https://doi.org/10.1111/j.1540-8167.1996.tb00562.x.
5. Swerdlow CD, Asirvatham SJ, Ellenbogen KA. et al. Troubleshooting implanted cardioverter defibrillator sensing problems I. Circulation. Arrhythmia and Electrophysiology. 2014;7(6): 1237-1261. https://doi.org/10.1161/CIR-CEP.114.002344.