Key result
RV lead sensitivity adjustment eliminates atrial oversensing and inappropriate shocks post CRT-D with LBBP.
Case Report (n=1)
No
Sensitivity adjustment of the RV lead can successfully eliminate oversensing of atrial signals by the ventricular coil lead during atrial fibrillation in patients with CRT-D and LBBP.
May warrant RV sensitivity adjustment to avoid inappropriate shocks in AF post-LBBP; leaves open dedicated programming studies.
A 70-year-old female with ischemic cardiomyopathy and complete heart block presented with recurrent syncope and an episode of massive chest pain, one month after CRT-D with LBBP implantation. Device interrogation revealed oversensing of atrial signals by the ventricular coil lead during atrial fibrillation leading to inappropriate VF detection, which was causing both inappropriate pacing inhibition and shock delivery. Sensitivity adjustment of the RV lead successfully eliminated oversensing. This case is a unique occurrence of a double inappropriate response to oversensing. We discuss in detail the reasons behind oversensing and steps for optimization of programming to treat such adverse events.
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Jebamalar et al. (2026) conducted a case report in Ischemic cardiomyopathy and complete heart block (n=1). Sensitivity adjustment of the RV lead was evaluated on Elimination of oversensing. Sensitivity adjustment of the RV lead successfully eliminated oversensing of atrial signals causing inappropriate pacing inhibition and shock delivery in a patient post CRT-D with LBBP implantation.
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