Failure of CRT-D's Sensing Lead to Correctly Detect Vfib as a Result of Inter-Ventricular Conduction Abnormality Induced by Cardiac Sarcoidosis

概要

論文の詳細を見る
A 59 year old male with a history of cardiac sarcoidosis (CS) and a CRT-D has visited our facility since he noticed an alarm was sounding from his CRT-D. An ECG showed Vfib, nevertheless the CRT-D did not function, and therefore the patient received external defibrillation. The possibility that the CRT-D's shock sensing lead was not detecting the form of Vfib was suspected. The sensing lead was able to detect only half of the electric potential of 180 bpm VT triggered intentionally by T-wave shock. Also the lead could only detect high-amplitude electric potential. Hence, we assumed that rate depending functional block was occurring, and implemented EPS using a CARTO system. Voltage map showed that only the area from the RVA to the inferior area had a normal voltage, whereas the RVOT area, where the sensing lead was implanted had low voltage. Potential caused by burst pacing was conducted from RVA to the sensing lead in Wenckebach like conduction. When VT with a rate over 170 bpm was induced, two to one or three to two conduction was seen. We concluded that CS had caused inter-ventricular conduction abnormality, thus led to the sensing lead's failure to detect Vfib. An additional sensing lead was implanted to properly sense Vfib.