Left ventricular sensing in cardiac resynchronization devices—opportunities and pitfalls for device programming. (4th July 2019)

• Record Type: Journal Article
• Authors: Haeberlin, Andreas; Ploux, Sylvain; Noel, Antoine; Chauvel, Rémi; Welte, Nicolas; Marchand, Hugo; Haissaguerre, Michel; Ritter, Philippe; Bordachar, Pierre
• Is Part Of: Journal of cardiovascular electrophysiology. Volume 30:Number 8(2019)
• Page Start: 1352
• Page End: 1361
• Publication Date: 2019-07-04
• Subjects: cardiac resynchronization therapy -- left ventricular lead -- left ventricular sensing -- lock‐in; Blood vessels -- Physiology -- Periodicals; Electrophysiology -- Periodicals; Heart -- Physiology -- Periodicals; 612.1
• DOI: 10.1111/jce.14039
• Languages: English
• ISSNs: 1045-3873

Abstract

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.