Crosstalk, mode switch and decrease in the percentage of BiV stimulation
Tracing
Manufacturer Microport CRM
Device CRT
Field Standard parameters
N° 9
Patient
This 59-year-old man received a Microport CRM-Sorin Intensia SonR triple chamber defibrillator in the context of ischemic cardiomyopathy with long PR interval and left bundle branch block. Episodes of mode switch were detected during a follow-up device interrogation.
Graph and trace
Graph
- 1:1 AV association.
- alternans of short - long cycles at the atrial level.
- 1:1 AV association.
- alternans of short - long cycles at the atrial level.
- 1:1 AV association.
Tracing
- atrial sensing, BiV stimulation (with programmed V-V delay) and crosstalk (sensing of ventricular depolarization by the atrial channel).
- mode switch in DDI mode.
- AV conduction with long PR.
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EGM recordings
This tracing is similar to the previous one, with mode switch prompted by prolonged crosstalk. In this pacemaker non-dependent patient, this inappropriate mode switch was associated with an interruption of BiV stimulation and return of spontaneous rhythm. The rail-like appearance of the graph is characteristic of crosstalk. As in the previous case, crosstalk could be suppressed by a) lowering the atrial sensitivity (at the risk of undersensing episodes of AF), or b) extending the post-ventricular atrial blanking (at the risk of undersensing 2:1 atrial flutter), or c) both interventions.