Is This VT or BIV Pacing?

Document Type

Conference Proceeding

Publication Date

4-2-2024

Publication Title

Journal of the American College of Cardiology

Abstract

Background: Change in BiV pacing morphology with PMT as a consequence of aberrancy is not described. Case: 78-year-old man with ICM EF 20% with Boston Scientific BiV ICD developed wide complex tachycardia with change in QRS axis (Figure 1). His ICD was programmed with an AV delay of 180 ms and sensed AV delay at 120 ms. He was sent urgently to the EP clinic due to concern for VT while in cardiac rehab. Decision-making: His ICD was interrogated and showed 1st and 2nd beat was BiV trigger pacing due to LV PVC. The corresponding sinus beats were refractory. The 3rd beat triggered tracking preference which shortened PVARP which allowed the next sinus beat to be tracked at MTR. This change in BiV pacing rate explains QRS morphology as a consequence of delayed myocardial conduction at higher rate. Therefore, this is BiV pacing and not VT. Conclusion: Atrial tracking was turned off to prevent BiV tracking at MTR to prevent increased tracking rate as a consequence of device programming. This is the 1st case of BiV pacing at high HR being mistaken as VT. Recognizing changes in BiV pacing morphology, close exam of device parameters is helpful in such cases. The rate at which PMT happens is dependent on the AV delay and the VA conduction times. PMT can be managed by increasing the length of the PVARP so that a retrogradely conducted ventricular beat will no longer be sensed by the atrial lead since the PVARP duration has passed.

Volume

83

Issue

13 Suppl

First Page

3678

Comments

American College of Cardiology 73rd Annual Scientific Session & Expo, April 6-8, 2024, Atlanta, GA

DOI

10.1016/S0735-1097(24)05668-7

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