T-Wave Oversensing

Patient

78 years old woman, implanted with a triple chamber defibrillator Viva XT CRT-D for ischemic cardiomyopathy with a large QRS ; routine follow-up and episode of T-wave oversensing



Trace

Plot

  1. alternation of different frequencies ;
  2. alternation between two ventricular cycles;

Tracing

  1. biventricular stimulation ;
  2. T-wave oversensing (TS) following a paced ventricular event;
  3. this ventricular sensed event (TS) is considered as a premature ventricular contraction and trigger a prolongation of the PVARP; The next spontaneous atrial event fall in the PVARP (AR) and conduct a spontaneous QRS (VS) ;
  4. late T-wave oversensing following the spontaneous ventricular event ; the next spontaneous atrial depolarization is even closer to this T-wave, and fall this time in the post ventricular atrial blanking, and is labeled Ab ;
  5. as a consequence, The next spontaneous ventricule is detected in the fast VT via VF zone (TF.) ;
  6. identical sequence ;
  7. diagnosis of T-wave oversensing made by the device; therapies are withhold;

Text

  1. diagnosis of T-wave oversensing made by the device;

Comments

Programming the new algorithm for the discrimination of the T wave oversensing can inhibit and prevent the occurrence of inappropriate therapies. This algorithm identifty alternation between two different cycles and signals (R-waves and T waves) of different amplitudes.

In this patient, the T wave oversensing is responsible for a decrease in the percentage of biventricular pacing. To avoid this oversensing, it is possible to change the programming of the right ventricular sensing polarity (bipolar to integrated bipolar). In this patient, this change did not had a positive effect. In contrast, reducing the ventricular sensitivity from 0.3 to 0.6 mV eliminated the oversensing. However, to certify the accurate detection of ventricular signals during an episode of arrhythmia, a FV induction test was performed with this new ventricular sensitivity.

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