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A fortuitous syncope. The pitfalls of integrated bipolar defibrillator leads.

Salukhe TV, Wright I, Wright M, Kanagaratnam P, O'Neill MD - Indian Pacing Electrophysiol J (2008)

Bottom Line: Current literature is dominated by reports of diaphragmatic muscle as the source of such far-field oversensing.Those reporting pectoral muscle sources were invariably due to unipolar sensing circuits, incorrect DF-1 connections or inappropriate programming.We report an interesting case of pectoral muscle myopotential oversensing causing inhibition of bradycardia pacing leading to presyncope and syncope.

View Article: PubMed Central - PubMed

Affiliation: Department of Cardiac Electrophysiology, St Mary's Hospital and Imperial College, London, UK. salukhe@aol.com

ABSTRACT
Myopotential oversensing in implantable defibrillators causing inhibition of pacing and inappropriate therapies is well described. Current literature is dominated by reports of diaphragmatic muscle as the source of such far-field oversensing. Those reporting pectoral muscle sources were invariably due to unipolar sensing circuits, incorrect DF-1 connections or inappropriate programming. We report an interesting case of pectoral muscle myopotential oversensing causing inhibition of bradycardia pacing leading to presyncope and syncope.

No MeSH data available.


Related in: MedlinePlus

Recorded episode of diverted therapy. Atrial electrogram (top) ventricular electrogram (middle) and paced electrogram (bottom). Black arrows indicate non-physiological potentials
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Figure 1: Recorded episode of diverted therapy. Atrial electrogram (top) ventricular electrogram (middle) and paced electrogram (bottom). Black arrows indicate non-physiological potentials

Mentions: Device interrogation revealed 16 diverted therapies in the VF zone. One such episode is shown in Figure 1. The atrial electrogram confirms atrial fibrillation. The ventricular electrogram demonstrates a paced beat followed by potentials which are clearly not physiological. These high frequency potentials, detected within the VF zone had two consequences - inhibition of ventricular pacing and device capacitor charging. The prolonged asystole in this pacing-dependant patient eventually, and rather fortuitously, results in syncope which coincides with the disappearance of the non-physiological potentials. As a result, ventricular pacing resumes and defibrillation is diverted.


A fortuitous syncope. The pitfalls of integrated bipolar defibrillator leads.

Salukhe TV, Wright I, Wright M, Kanagaratnam P, O'Neill MD - Indian Pacing Electrophysiol J (2008)

Recorded episode of diverted therapy. Atrial electrogram (top) ventricular electrogram (middle) and paced electrogram (bottom). Black arrows indicate non-physiological potentials
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2572022&req=5

Figure 1: Recorded episode of diverted therapy. Atrial electrogram (top) ventricular electrogram (middle) and paced electrogram (bottom). Black arrows indicate non-physiological potentials
Mentions: Device interrogation revealed 16 diverted therapies in the VF zone. One such episode is shown in Figure 1. The atrial electrogram confirms atrial fibrillation. The ventricular electrogram demonstrates a paced beat followed by potentials which are clearly not physiological. These high frequency potentials, detected within the VF zone had two consequences - inhibition of ventricular pacing and device capacitor charging. The prolonged asystole in this pacing-dependant patient eventually, and rather fortuitously, results in syncope which coincides with the disappearance of the non-physiological potentials. As a result, ventricular pacing resumes and defibrillation is diverted.

Bottom Line: Current literature is dominated by reports of diaphragmatic muscle as the source of such far-field oversensing.Those reporting pectoral muscle sources were invariably due to unipolar sensing circuits, incorrect DF-1 connections or inappropriate programming.We report an interesting case of pectoral muscle myopotential oversensing causing inhibition of bradycardia pacing leading to presyncope and syncope.

View Article: PubMed Central - PubMed

Affiliation: Department of Cardiac Electrophysiology, St Mary's Hospital and Imperial College, London, UK. salukhe@aol.com

ABSTRACT
Myopotential oversensing in implantable defibrillators causing inhibition of pacing and inappropriate therapies is well described. Current literature is dominated by reports of diaphragmatic muscle as the source of such far-field oversensing. Those reporting pectoral muscle sources were invariably due to unipolar sensing circuits, incorrect DF-1 connections or inappropriate programming. We report an interesting case of pectoral muscle myopotential oversensing causing inhibition of bradycardia pacing leading to presyncope and syncope.

No MeSH data available.


Related in: MedlinePlus