T wave oversensing represents one of the common inappropriate shocks in patients with cardiac defibrillators. This case report demonstrates a non-invasive clue to eliminate the aforementioned problem. We experienced an 82-year-old male with non-ischemic dilated cardiomyopathy who underwent CRT-D implantation. Seven months after the implantation surgery, he experienced abrupt shocks without any symptom and we interrogated his CRT-D device, which demonstrated the status of the three leads was acceptable and such inappropriate shocks had been delivered by misdiagnosing as ventricular fibrillation due to double or triple counts of high T waves and frequent premature ventricular contractions. His iplilateral subclavian vein was chronically occluded and the patient rejected further invasive strategies such as another lead insertion or device exchange. In this situation we evaluated whether change of VV timing may alter ventricular intracardiac electrogram. By sequential biventricular pacing in which LV pacing remarkably preceded RV pacing, we could successfully increase V wave amplitude with significant reduction of accompanying T wave, finally eliminating inappropriate diagnosis. This setting did not worsen cardiac performance and ventricular sensing to detect true tachyarrhythmia. In the oversensing of T wave, alteration of VV delay timing is a choice of the recommendable strategies to prevent inappropriate shock.
|Original language||English (US)|
|Number of pages||4|
|State||Published - Apr 20 2011|
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