Key result
Inappropriate automatic mode switch due to far-field R wave oversensing caused loss of AV synchrony and clinical worsening in a patient with a cardiac resynchronization therapy device.
Case Report (n=1)
Inappropriate automatic mode switch due to far-field R wave oversensing can cause significant clinical worsening in CRT patients, which may require adjustment of atrial channel sensitivity.
We describe a case of a 65-year-old gentleman with nonischemic cardiomyopathy and left bundle branch block who underwent cardiac resynchronization therapy device. After becoming a responder initially, he experienced significant clinical worsening on follow-up. Device interrogation revealed several long episodes of inappropriate automatic mode switch (AMS) entry due to far-field R wave oversensing resulting in loss of atrioventricular synchrony. Moreover, pacing in VVI mode with consistent VA conduction taking place during the AMS episodes was also found to be detrimental, which helped in sustaining the episodes and produced pacemaker syndrome like phenomenon. Attempts made to resolve the issue by prolonging the post-ventricular atrial blanking period was unsuccessful, hence we adjusted the atrial channel sensitivity to troubleshoot the problem.
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Bera et al. (2020) conducted a case report in Nonischemic cardiomyopathy and left bundle branch block (n=1). Cardiac resynchronization therapy device was evaluated. Inappropriate automatic mode switch due to far-field R wave oversensing caused loss of AV synchrony and clinical worsening in a patient with a cardiac resynchronization therapy device.
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