It was reported that an alert was received through latitude due to right ventricular (rv) automatic threshold detected as greater than programmed amplitude or suspended.Upon further review, it was discussed that there is left ventricular (lv) oversensing, which results in inhibition of biventricular pacing.The patient is not pacemaker dependent.It was also mentioned that the alert received is due to fusion and intrinsic beat events, which is likely a result of the abnormal sensed events in the lv.Further in-clinic assessment was recommended as there is the possibility that the right atrial (ra) and lv leads are reversed in the device header, or the ra and lv leads position could be suboptimal.Troubleshooting suggestions were provided.In addition, the presenting electrogram (egm) continues to show atrio-ventricular desynchrony and there is no atrial capture.In-clinic testing was performed and the lead tests confirmed the atrial and left ventricular leads are likely reversed in the header.As a result, the device has been reprogrammed for the time being and the lead revision procedure has been scheduled.Lead revision was performed as scheduled and the lv and ra leads were adequately connected to the device header.The lead tests are showing appropriate measurements and the sensitivity was adjusted.The cardiac resynchronization therapy defibrillator (crt-d) system remains in service.No additional adverse patient effects were reported.
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