Unusually high His-bundle signal amplitude — ICD sensing considerations
Abstract
In patients with chronic atrial fi brillation and congestive heart failure presenting with narrow QRS complex the direct
His-bundle pacing the use of dual chamber implantable cardioverter-defibrillator can be a defi nite treatment option
meeting all therapeutic goals. This approach enables heart rate regularization, appropriate increase of beta-blocker
dose with additional benefi t in terms of arrhythmic death prophylaxis. The proper functioning of implantable cardioverter-
-defibrillator demands appropriate atrial channel/His-bundle signal sensing. The low His-bundle electrogram amplitude
usually does not interfere with the device function and the DDI or DVI programming modes are reasonable.
The authors present a case of unusually high His-bundle signal amplitude sensed by atrial channel of implantable cardioverter-defibrillator, which could potentially contribute to some particular programming considerations. The attending physician should be aware of some arrhythmia discriminators which may delay or even withhold the appropriate shock.
Keywords: atrial fi brillationcongestive heart failuredirect His-bundle pacingimplantable cardioverter-defibrillator
References
- Sławuta A, Mazur G, Małecka B, et al. Permanent His bundle pacing - An optimal treatment method in heart failure patients with AF and narrow QRS. Int J Cardiol. 2016; 214: 451–452.
- Clark DM, Plumb VJ, Epstein AE, et al. Hemodynamic effects of an irregular sequence of ventricular cycle lengths during atrial fibrillation. J Am Coll Cardiol. 1997; 30(4): 1039–1045.
- Deshmukh P, Casavant DA, Romanyshyn M, et al. Permanent, direct His-bundle pacing: a novel approach to cardiac pacing in patients with normal His-Purkinje activation. Circulation. 2000; 101(8): 869–877.
- Sławuta A, Biały D, Zyśko D, et al. His-bundle pacing using dual-chamber cardioverter–defibrillator in patients with chronic atrial fibrillation: different pacing and sensing features. Acta Cardiol. 2017 [ahead-of-print]: 1–2.
