Johnsrude Christopher L, Lau Kelvin C
Division of Pediatric Cardiology, Department of Pediatrics, University of Louisville, Louisville, KY, USA.
J Innov Card Rhythm Manag. 2019 Oct 15;10(10):3848-3852. doi: 10.19102/icrm.2019.101001. eCollection 2019 Oct.
Capture management algorithms in current cardiac implantable electronic devices (CIEDs) can enhance device performance and battery longevity. Although generally safe, these algorithms have on rare occasions been implicated in the onset of significant complications, especially in pacemaker-dependent patients. CIEDs implanted in patients with postoperative congenital heart disease (CHD) often require epicardial pacing leads rather than transvenous leads; unfortunately, epicardial leads can experience higher rates of malfunction. We herein report on a young adult with a status of postoperative CHD and complete atrioventricular block following implantation of a epicardial dual-chamber cardiac resynchronization therapy pacemaker (CRT-P; Consulta; Medtronic, Minneapolis, MN, USA) who developed frequent periods of asystole after malfunction of one of the ventricular leads. The underlying cause of asystole was found to be due to the atrial capture management (ACM) algorithm of the CRT-P device, temporarily converting biventricular to right ventricular-only pacing as part of the algorithm. This case highlights implications of the ACM algorithm in devices with a similar platform for pacemaker-dependent patients.
当前心脏植入式电子设备（CIED）中的捕获管理算法可提高设备性能并延长电池寿命。尽管这些算法通常是安全的，但在极少数情况下，它们与严重并发症的发生有关，尤其是在依赖起搏器的患者中。植入术后先天性心脏病（CHD）患者的CIED通常需要心外膜起搏导线而非经静脉导线；不幸的是，心外膜导线出现故障的几率更高。我们在此报告一名患有术后CHD且植入心外膜双腔心脏再同步治疗起搏器（CRT-P；康索拉；美敦力公司，美国明尼阿波利斯，MN）后出现完全房室传导阻滞的年轻成人，该患者在一根心室导线发生故障后频繁出现心脏停搏。发现心脏停搏的根本原因是CRT-P设备的心房捕获管理（ACM）算法，作为该算法的一部分，该算法会暂时将双心室起搏转换为仅右心室起搏。该病例突出了ACM算法在具有类似平台的设备中对依赖起搏器患者的影响。
