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Transmission

We observe an alert for percentage of biventricular pacing below 80%. Often this is caused by onset of atrial fibrillation. However, like in the previous case, we see no evidence of atrial fibrillation. However on the real time EGM, we do see premature ventricular complexes (PVCs). These ventricular events are sensed and therefore decrease the %CRT (%biV) counter and trigger the alert. Different to previous case, the PVCs are much more numerous as they occur after every paced beat. This is called ventricular bigeminy and is associated with significant drops in CRT (65% CRT remaining in this case).

Next steps

As explained in the previous case, for CRT to be effective, the patient needs to receive at least 90/95 % CRT with full biventricular (or at least LV) capture. There was no direct cause but the patient reported decreased exercise tolerance. Bisoprolol was improved and she was included into a remote monitoring system for heart failure.