Pacemaker‐mediated tachycardia in a dual‐lead CRT‐D: What is the mechanism?. Issue 1 (8th November 2020)

• Record Type: Journal Article
• Authors: Monkhouse, Christopher; Cambridge, Alex; Chow, Anthony W.C.; Behar, Jonathan
• Is Part Of: Pacing and clinical electrophysiology. Volume 44:Issue 1(2021)
• Page Start: 151
• Page End: 155
• Publication Date: 2020-11-08
• Subjects: cardiac resynchronisation therapy -- dual left ventricular lead -- heart failure exacerbation -- pacemaker‐mediated tachycardia -- TriVentricular; Cardiac pacing -- Periodicals; Electrophysiology -- Periodicals; 617.4120645
• DOI: 10.1111/pace.14089
• Languages: English
• ISSNs: 0147-8389

Abstract

Abstract: A 73‐year‐old gentleman with dilated cardiomyopathy, left bundle branch block and a left ventricular (LV) ejection fraction of 20% was implanted with two LV leads in a tri‐ventricular cardiac resynchronisation therapy defibrillator (CRT‐D) trial. As a part of the trial he was programmed with fusion‐based CRT therapy with dual LV lead only pacing. The patient presented to local heart failure service 12 years after implant, after a positive response to CRT therapy, with increase in fatigue, shortness of breath and bilateral pitting oedema. The patient sent a remote monitoring transmission that suggested loss of capture on one of the LV leads. This coupled with atrial ectopics was producing a high burden of pacemaker‐mediated tachycardia (PMT) that was not seen when both LV leads had been capturing. What is the mechanism for this? Dual LV‐lead tri‐ventricular leads have been shown to have variable improvements in CRT response but with an increased complexity of implant procedure. This is the first case report of PMT‐induced heart failure exacerbation in a tri‐ventricular device following loss of LV capture of one lead.