Abstract
A 73-year-old man with nonischemic cardiomyopathy underwent catheter ablation of ventricular tachycardia that had resulted in frequent shocks from his implanted cardiac resynchronization therapy defibrillator (CRT-D). Coexisting atrial fibrillation required AV node ablation which rendered the patient pacemaker dependent. During follow-up, recurrent episodes of dizziness occurred caused by inhibition of pacing due to oversensing of pectoral muscle myopotentials. Surgical revision was performed and the intraoperative examination revealed an intact integrated bipolar defibrillator lead with appropriate connections to the CRT-D header. The placement of an additional pace/sense lead completely resolved the patient’s symptoms and no further myopotential oversensing was recorded.
Zusammenfassung
Bei einem 73-jährigen Mann mit nichtischämischer Kardiomyopathie wurde eine Katheterablation einer medikamentös therapierefraktären ventrikulären Tachykardie durchgeführt, da diese zu zahlreichen Schocks seines implantierten Defibrillators zur kardialen Resynchronisationstherapie (CRT-D) geführt hatte. Ein gleichzeitig bestehendes Vorhofflimmern erforderte eine Ablation des AV-Knotens, nach der eine Schrittmacherabhängigkeit bestand. In der Folge klagte der Patient über rezidivierenden Schwindel, welcher durch eine Inhibition der Stimulation bei Oversensing von Myopotenzialen des M. pectoralis verursacht wurde. Die während der operativen Revision durchgeführte Überprüfung ergab den Befund einer intakten und korrekt mit dem CRT-D-Aggregat konnektierten integrierten bipolaren Defibrillatorsonde. Nach zusätzlicher Implantation einer rechtsventrikulären Pace/Sense-Sonde sistierte die Schwindelsymptomatik und ein Myopotenzial-Oversensing wurde nicht mehr registriert.
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Conflict of interest
The corresponding author states the following: M. Roser and W. Haverkamp have received lecture fees from Medtronic.
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Dorenkamp, M., Boldt, LH., Blaschke, F. et al. Unmasking of myopotential oversensing by an integrated bipolar defibrillator lead following AV node ablation. Herzschr. Elektrophys. 23, 131–134 (2012). https://doi.org/10.1007/s00399-012-0172-3
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DOI: https://doi.org/10.1007/s00399-012-0172-3
Keywords
- Cardiac resynchronization therapy
- Implantable cardioverter–defibrillator
- Myopotential oversensing
- Inhibition of pacing
- Cardiomyopathy