RESUMO
Detection of high rate episodes can potentially result from oversensing of physiological or nonphysiological signals. Assessment of lead integrity, lead connection and analysis of noise characteristics on electrograms are decisive steps in the evaluation of oversensing. We report a case of high atrial and ventricular rate episodes due to minute ventilation oversensing in the presence of lead connector issues.
Assuntos
Bloqueio Atrioventricular/terapia , Marca-Passo Artificial , Artefatos , Eletrocardiografia , Desenho de Equipamento , Análise de Falha de Equipamento , Humanos , Masculino , Pessoa de Meia-Idade , SoftwareRESUMO
A 40 year old man with frequent PVCs with two different morphologies was referred for catheter ablation. Although initial mapping in the RVOT revealed fragmented potentials 20ms earlier than PVC2 onset with a good pace map score, ablation at this site was unsuccessful. Subsequent mapping in the LCC/NCC junction revealed that local ventricular activation preceded QRS onset by 30 and 28 ms for PVC1 and PVC2, respectively. Altering the pacing output at this site produced QRS morphologies similar to PVC1(low output,6mA) and PVC2(high output,15mA) with better pace map scores compared to RVOT. During high-output pacing, there was an increase in stim-QRS latency with decremental conduction. Ablation at this site was successful and suppressed both PVCs.
