Key result
CRT-P far-field R wave oversensing causes false atrial tachycardia and symptomatic inadvertent AV block.
Case Report (n=1)
This case highlights a complex pacemaker troubleshooting scenario where far-field R wave oversensing combined with P wave under-sensing leads to symptomatic atrioventricular block during biventricular pacing.
Far-field R wave (FFRW) oversensing in atrial channel is known to cause inappropriate automatic mode switch. We describe a case of 63-year-old lady with dual-chamber permanent pacemaker implanted 2 years back for symptomatic infra-hisian complete heart block and normal biventricular function. After 6 months, she underwent upgradation to cardiac resynchronization therapy (CRT-P, Boston Scientific) for right ventricular pacing induced cardiomyopathy. Her LV function normalized after CRT. Later on, FFRW oversensing caused false triggering of an atrial tachycardia, which subsequently opened up an "atrial flutter response" window leading to symptomatic inadvertent atrioventricular block at frequent intervals. Common ways to troubleshoot FFRW oversensing are either by increasing post-ventricular atrial blanking or reducing atrial channel sensitivity. In her case, concomitant P wave under-sensing made the situation more challenging to manage.
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Bera et al. (2020) conducted a case report in Far-field R wave oversensing and symptomatic atrioventricular block (n=1). Cardiac resynchronization therapy (CRT-P) was evaluated. Far-field R wave oversensing in a patient with a CRT-P device caused false triggering of atrial tachycardia and symptomatic inadvertent atrioventricular block, complicated by P wave under-sensing.
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