It was reported that when the patient presented in clinic after being transferred from another hospital, it was noted that the patient received four inappropriate shocks due to double counting rv pacing depolarization since the device was at maximum output.The previous hospital erased all the egms and there was no record to view.The patient has an icd implanted in the abdomen, and a pacemaker implanted in the left pectoral.Device was reprogrammed by the previous hospital.Analysis of the egms shows likely oversensing of pacing output.It was suspected that the pacemaker is likely tracking a sinus tachycardia, with conducted qrs's seen on the vf episode.The rv output was not capturing but was being sensed by the icd as well as intrinsic qrs.This was leading to diagnosis of vf and delivery of therapy.It was recommended to explant the pacemaker since there is the possibility of increased outputs during bvvi, as well as having two devices is contraindicated.Device was checked and is functioning normal now.Patient is doing fine.
|