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- W4377015320 abstract "Automatic capture management (ACM) algorithms are extremely reliable and routinely used in cardiac resynchronization therapy devices including left ventricular (LV) leads. We report a case of failure of ACM in a patient with biventricular (BiV) ICD with unusual late dislodgement of left bundle branch pacing (LBBP) lead. The present case highlights a unique challenge in patients BiV ICD with a LBBP lead in the left ventricular (LV) port who are programmed to subthreshold right ventricular (RV) outputs to promote only LBBP with RV fusion. A 74-year-old man with nonischemic cardiomyopathy, LVEF 20% and LBBB underwent successful BIV ICD utilizing LBBP lead in LV port (Nov 2020). RV output was programmed to subthreshold to promote LV only pacing. LBBP lead threshold was stable at 1V at 6-month follow-up at which time LVEF had normalized. ACM was programmed in the atrial and LV lead. During remote follow-up at 1 year (Dec 2021) it was noted that the device had stopped assessing LV capture threshold/impedance on August 2021(blue circles). Presenting rhythm demonstrated BiV pacing spikes without capture but conducted beats from sinus rhythm (AS) sensed as VF event (arrow). LV ACM was not attempted by the device due to the ongoing AS-BP-TF resulting in tachycardia detection count of 20/40. When the detection count is 3 or greater (or has actually detected an episode) the device will suspend lower priority functions including, but not limited to, capture management and impedance measurements. This unusual failure of ACM to detect loss of capture from late dislodgement of the LBBP lead occurred due to subthreshold RV output, loss of LV capture and long native AV conduction resulting in sensed event outside the blanking period. LBBP was successfully replaced. We present an unusual case of late dislodgement of LBBP lead 10 months after implant in whom ACM failed as it was suspended due to ongoing higher-priority event such as VT detection." @default.
- W4377015320 created "2023-05-19" @default.
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- W4377015320 date "2023-05-01" @default.
- W4377015320 modified "2023-09-27" @default.
- W4377015320 title "PO-04-011 FAILURE OF LEFT VENTRICLE CAPTURE MANAGEMENT ALGORITHM TO DETECT LEAD DISLODGMENT: AN UNUSUAL MECHANISM" @default.
- W4377015320 doi "https://doi.org/10.1016/j.hrthm.2023.03.1236" @default.
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