Hyperglycemia-induced t-wave oversensing as a cause of cardiac resynchronization therapy [CRT] failure

ABSTRACT

T-wave overs ens ing occurs when the counter starts giving dual beeps for every cardiac cycle instead of one. This usually happens when the monitoring lead displays a tall T wave, which is also sharp. R wave sensing algorithms of the devices do not sense Twave because the slow rate of the Twave is much less than that of the R wave. But the slow rate of'T'waves may change with time and also because of parameters like potassium levels and hyperglycemia. We present a 67-year-old female who underwent the implantation of cardiac resynchronization therapy [cardiac resynchronization and implantable cardioverter defibrilator [CRT-D]] because of severe left ventricular systolic dysfunction and ventricular dyssynchrony experienced recurrent inappropriate implantable cardioveYter-defibrillator [ICD] shocks and CRT failure. Device analysis showed that the CRT failure was in consequence of T-wave oversensing due to hyperglycemia. Elimination of the T-wave oversensing after hyperglycemia control conferred good biventricular pacing and good response to CRT during a 6-month follow-up period