A Case of a Cardiac Resynchronization Therapy-Defibrillator Exhibiting a Lower and Alternately Variable Basic Rate
| Autor: | Nobuaki Fukuma, Jun Matsuda, Hikaru Tanimoto, Jun Yokota, Takahide Murasawa, Keigo Iwazaki, Katsuhito Fujiu, Kyungho Chang, Hitoshi Kubo, Toshiya Kojima, Issei Komuro, Eriko Hasumi, Takumi Matsubara, Yu Shimizu, Gaku Oguri |
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| Rok vydání: | 2018 |
| Předmět: |
Cardiac function curve
Male medicine.medical_specialty medicine.medical_treatment Cardiac resynchronization therapy Catheter ablation 030204 cardiovascular system & hematology Ventricular tachycardia Cardiac Resynchronization Therapy 03 medical and health sciences Electrocardiography 0302 clinical medicine Heart Rate Internal medicine medicine Humans cardiovascular diseases 030212 general & internal medicine Atrial tachycardia Aged Heart Failure medicine.diagnostic_test business.industry VA conduction Arrhythmias Cardiac General Medicine medicine.disease Defibrillators Implantable Heart failure cardiovascular system Cardiology medicine.symptom Cardiology and Cardiovascular Medicine business Algorithms |
| Zdroj: | International heart journal. 59(3) |
| ISSN: | 1349-3299 |
| Popis: | A cardiac resynchronization therapy defibrillator (CRT-D) (Medtronic Inc. Protecta XT) was implanted in a 67-year-old man who had cardiac sarcoidosis with extremely low cardiac function. He had ventricular tachycardia which was controlled by catheter ablation, medication and pacing. The programmed mode was DDI, lower rate was 90 beats/minute, paced AV delay was 150 ms, and the noncompetitive atrial pacing (NCAP) function was programmed as 300 ms.After his admission for pneumonia and heart failure, we changed his DDI mode to a DDD mode because he had atrial tachycardia, which led to inadequate bi-ventricular pacing. After a while, there were cycle lengths which were longer than his device setting and alternately varied. We were able to avoid this phenomenon with AV delay of 120 ms and NCAP of 200 ms.NCAP is an algorithm which creates a gap above a certain period after the detection of an atrial signal during the postventricular atrial refractory period of the pacemaker. This is to prevent atrial tachycardia and repetitive non-reentrant ventriculoatrial (VA) synchrony in the presence of retrograde VA conduction. But in this case, NCAP algorithm induced much lower rate than the programmed basic lower rate. This situation produced some arrhythmias and exacerbated symptoms of heart failure. This had to be paid attention to, especially when the device was programmed at high basic heart rate. |
| Databáze: | OpenAIRE |
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