Drop in percentage CRT (2)
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CRT in patients with His-ablation due to LV dysfunction and fast conducted AF has become an important treatment. Studies have been so positive that it now enjoys a class I recommendation in the 2021 ESC guidelines. Loss of CRT due to AV conduction (supraventricular arrhythmias or sinus tachycardia) is impossible in these patients but ventricular arrhythmia may very well be a cause, such as in this patient.
Statistics show low %CRT in the past few weeks due to 25-50% sensed events.
The rate rate curves show that this since a few months, there has been a progressive decrease in %CRT.
The management of PVCs includes identification of structural triggers such as ischemia or valvular disease. Mostly a treatment with beta-blockers or other arrhythmic drugs suffices but sometimes radiofrequency ablation of the PVCs may be reauired.
You prescribed the patient with 10 mg Bisoprolol daily and see him back a few months later. He feels much better now. The EGM during interrogation shows no more premature ventricular complexes.
The following programmer screens confirm the dramatic lowering of PVCs, restoring %CRT to 100%.
Soon after the initiation of béta-blockers, the V sensed (green) bar diminishes.
The effect is sustainted during follow-up.
The %CRT curve (V pacing graph) recovers to near 100%.
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63 year-old male with dilated cardiomyopathy and atrial fibrillation with fast ventricular rate was implanted with a CRT-D (Paradym RF SonR) . Three days after implantation he underwent successful His-node ablation. In the first three years after implantation he felt much better. However, he has developed more dyspnea since the last device check-up 6 months ago (NYHA III). You perform an interrogation and see the following alert on the programmer screen.
This is the EGM during interrogation:
What is the most probable reason for drop in CRT?CorrectIncorrect