Key result
Targeted ICD reprogramming using ventricular far-field signals resolves His-channel undersensing and avoids lead revision.
Why the study?
His-bundle pacing connected to the atrial port of a dual-chamber ICD may lead to sensing failure and unsafe pacing.
Does targeted ICD reprogramming using ventricular far-field signals resolve His-channel undersensing and avoid lead revision in a patient with a His-bundle pacing lead connected to the atrial port of a dual-chamber ICD?
Case Report (n=1)
No
Does targeted ICD reprogramming using ventricular far-field signals resolve His-channel undersensing and avoid lead revision in a patient with a His-bundle pacing lead connected to the atrial port of a dual-chamber ICD?
Targeted device reprogramming utilizing ventricular far-field signals can successfully resolve His-bundle lead undersensing in a dual-chamber ICD, avoiding the need for invasive lead revision or reimplantation.
BACKGROUND: His-bundle pacing connected to the atrial port of a dual-chamber ICD may lead to sensing failure and unsafe pacing. CASE SUMMARY: A 67-year-old man with permanent atrial fibrillation, alternating rapid and slow ventricular rates despite medication, symptomatic pauses longer than 6s, and a dual chamber ICD (His lead in the RA port; DF4 lead in the RV port) presented with palpitations. ECG and 24-hour Holter demonstrated intermittent His-channel undersensing with pacing on the T-wave peak. Interrogation showed small His electrograms followed by a prominent, constant ventricular far-field signal on the atrial channel. We turned off far-field protection after V-sense, intentionally used the ventricular far-field signal for sensing of His lead, and disabled related discrimination algorithms. CONCLUSION: A dual-chamber ICD with a His-bundle pacing lead may be associated with complex programming challenges, and targeted reprogramming can avoid lead revision or reimplantation.
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Vo et al. (2026) conducted a case report in Permanent atrial fibrillation with His-channel undersensing in a dual-chamber ICD (n=1). Targeted ICD reprogramming (turning off far-field protection after V-sense, using ventricular far-field signal for His sensing, and disabling discrimination algorithms) was evaluated on Resolution of His-channel undersensing and avoidance of lead revision or reimplantation. Targeted ICD reprogramming using the ventricular far-field signal resolved intermittent His-channel undersensing in 1 patient (67-year-old man) with pauses >6s, avoiding lead revision.
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