Left ventricular sensing in cardiac resynchronization devices—opportunities and pitfalls for device programming

• Published in: Journal of cardiovascular electrophysiology Vol. 30; no. 8; pp. 1352 - 1361
• Main Authors: Haeberlin, Andreas, Ploux, Sylvain, Noel, Antoine, Chauvel, Rémi, Welte, Nicolas, Marchand, Hugo, Haissaguerre, Michel, Ritter, Philippe, Bordachar, Pierre
• Format: Journal Article
• Language: English
• Published: United States Wiley Subscription Services, Inc 01.08.2019
• Subjects: cardiac resynchronization therapy; Deactivation; Heart; left ventricular lead; left ventricular sensing; lock‐in; Medical personnel; Optimization; Synchronization; Troubleshooting; Ventricle; lock-in; left ventricular sensing; left ventricular lead; cardiac resynchronization therapy
• ISSN: 1045-3873; 1540-8167
• DOI: 10.1111/jce.14039

Introduction Some cardiac resynchronization therapy (CRT) device manufacturers (Biotronik, Germany; Boston Scientific, United States) have implemented left ventricular (LV) sensing functionality to prevent pacing into the vulnerable phase. Physicians are only partially aware of programming pitfalls related to LV sensing and general programming advice is lacking. Methods and Results We provide an illustrative case–series‐based review of the variety of potential problems with LV sensing. LV sensing may inappropriately impair CRT delivery due to LV‐sensing issues or improper device programming. This can cause beat‐wise loss of resynchronization but also ongoing desynchronization. On the other hand, LV sensing provides additional diagnostic information, which may reveal intermittent problems of the LV lead such as capture loss. We summarize the available evidence to provide manufacturer‐specific recommendations on device programming and troubleshooting for daily clinical practice. Conclusion CRT devices with LV sensing may suffer from impaired resynchronization due to programming pitfalls. If LV sensing is active (nominal setting in Biotronik and Boston Scientific devices), careful lookout for related problems and resynchronization percentage is required. Optimization is mandatory and even deactivation of LV sensing may have to be considered.