Drop in percentage CRT (2)
0 of 1 Questions completed
You have already completed the case before. Hence you can not start it again.
Case is loading…
You must sign in or sign up to start the case.
You must first complete the following:
Time has elapsed
- Not categorized 0%
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%.
- Review / Skip
Question 1 of 1
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