Ventricular asystole in a CRT-D device. What is the mechanism?

Pavan K V ReddyKhuyen DoRahul DoshiJerold ShinbaneTomas Konecny

Published in: Pacing and clinical electrophysiology : PACE (2019)

We present a case of an 89-year-old man with a left ventricular assist device and cardiac resynchronization therapy device (CRT-D) who presented with multiple presyncopal events. On the night of admission, telemetry revealed a 13-s pause with appropriately timed pacing spikes but with failure to capture, followed by intermittent ventricular contraction with different QRS morphology. What was the mechanism for his ventricular asystole?

Keyphrases

cardiac resynchronization therapy
left ventricular
heart failure
left ventricular assist device
emergency department
atrial fibrillation
physical activity
smooth muscle