Persistent Inhibition of the Left Ventricular Pacing Caused by the Left Ventricular Pacing Protection Function in Patients with Cardiac Resynchronization Therapy

概要

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Backgrounds: Some specific CRT devices can sense the left ventricular (LV) activation and inhibit the LV pacing to prevent R on T. However, only a little is known about the trouble caused by this function. We experienced some patients who had the persistent inhibition of the LV pacing in the setting of biventricular pacing. Methods: The occurrence of LV pacing inhibition (LPI) was investigated in consecutive 68 patients, who underwent the implantation of CRTDs with LV pacing protection (LVPP) function. LV sensing, LVPP and the RV sense-triggered LV pacing were activated in all the patients. Results: The persistent RV only pacing with the LPI was observed in 5 patients, despite the pacing setting was biventricular (n=4) or LV only (n=1). In 2 patients, the far-field atrial sensing caused the LPI, and one of them had the LV lead dislodgement. In the other 3 patient, oversensed T-wave or automatic prolongation of PVARP following PMT detection, concealed the atrial sensing. and the conducted RV to LV interval became shorter than the LV protection interval, and it caused the persistent LPI. Conclusion: Though the LVPP is useful in avoiding the risk of R on T, it possibly causes the persistent LPI in some specific situation.