Inappropriately long post-ventricular atrial blanking leading to 'unnecessary' defibrillator discharge.
Debabrata BeraAyan KarArya Kamal DasSuchit MajumderPublished in: Pacing and clinical electrophysiology : PACE (2022)
A 55-year-old lady with non-ischemic cardiomyopathy (NICM) was referred for multiple implantable cardioverter defibrillator (ICD) shocks. Stored electrograms (EGM) revealed atrial flutter (AFL) with A > V. Morphology match was good and RR-intervals were irregular. Despite all these, the dual-chamber-ICD (Abbott medical) classified this as ventricular tachycardia (VT-2) via V > A algorithm where it did not analyze morphology/stability and delivered therapy. Anti-tachycardia-pacing (ATP) was delivered which induced a true VT (rate in VF-zone) and immediate shock was delivered. It was hence appropriate but an 'unnecessary' shock. The offender was found to be an inappropriately programmed long post-ventricular atrial-blanking (PVAB) of 200 ms which led to undersensing of several atrial electrograms, falsely making V > A during a clear AFL.
Keyphrases
- catheter ablation
- atrial fibrillation
- left atrial
- heart failure
- left ventricular
- cardiac resynchronization therapy
- mass spectrometry
- healthcare
- machine learning
- multiple sclerosis
- stem cells
- deep learning
- ms ms
- diabetic rats
- single cell
- high glucose
- ischemia reperfusion injury
- oxidative stress
- room temperature
- subarachnoid hemorrhage
- neural network
- brain injury
- stress induced