The following EGMs are from a routine Sorin dual chamber pacemaker interrogation. Both EGMs were stored as “V Bursts”.
What is your analysis? The patient has complete heart block. Sensing, threshold, and impedance measurements were all stable.
AP 3%, VP >99%
The first recorded episode contains NSVT with appropriate sensing.
The second recording shows noise on both the atrial lead and ventricular lead happening concurrently. The noise on the RV lead is causing ventricular pacing inhibition with two approximately 2 second pauses.
Noise was not reproducible with isometrics or pocket manipulation. There was no prior evidence of lead noise. RV sensitivity was decreased from 1.8mV to 3.0mV to avoid oversensing/pacing inhibition on the RV lead due to the patient being dependent. Asynchronous programming was not considered at this time to maintain AV synchrony given the patient has intact sinus node function, but also to be able to detect future VT episodes.