DOUBLE INAPPROPRIATE RESPONSE IN A PATIENT POST CRT-D WITH LBBP IMPLANTATION

A 70-year-old female with ischemic cardiomyopathy and complete heart block presented with recurrent syncope and an episode of massive chest pain, one month after CRT-D with LBBP implantation. Device interrogation revealed oversensing of atrial signals by the ventricular coil lead during atrial fibrillation leading to inappropriate VF detection, which was causing both inappropriate pacing inhibition and shock delivery. Sensitivity adjustment of the RV lead successfully eliminated oversensing. This case is a unique occurrence of a double inappropriate response to oversensing. We discuss in detail the reasons behind oversensing and steps for optimization of programming to treat such adverse events.