Fullscreen Mode

Transmission

Similar to the previous case, we see alerts of drop in %CRT combined with notifications associated with AF. The real time EGM and summary curves confirm the onset of an AF episode. In contrary to the previous case, the onset of AF occurred several weeks ago and the %CRT has completely collapsed since then.

Next steps

This patient had a near complete loss of CRT for several weeks. The LV remodeling caused by CRT implantation can be made undone after a few weeks of therapy loss. In addition, we observe that prior to this episode, the patient has had multiple shorted episodes of atrial fibrillation. This patient, already under maximal rate control, is at risk of developing decompensated heart failure. Efforts need to be made to rapidly terminate the episode of AF (cardioversion) and/or discuss permanent solutions, such as AF ablation or His ablation, according to the clinical context.