Abstract
Accurate ventricular sensing is necessary for appropriate delivery of pacing and shocks. Ventricular oversensing can cause failure to pace in a pacer dependent patient. We describe a case of lead-device interaction causing oversensing and failure to pace after ventricular septal defect (VSD) occluder device placement. To our knowledge, this is the first report of lead-device interference with a VSD occluder device. N/A A 60 year old man with chronic stage D systolic heart failure, LVAD, and VSD underwent percutaneous VSD repair with an Amplatzer VSD occluder. In the immediate post-procedure period, he became bradycardic despite having an ICD with programmed brady-therapy. Device interrogation demonstrated normal impedance, sensing, and pacing parameters, but also revealed intermittent noise on both channels the near-field and the shock channel causing oversensing. Presence of noise on both channels was more consistent with device-device interaction than lead fracture. Fluoroscopic images revealed intermittent contact between the RV lead and VSD occluder. Adjustment of sensitivity, refractory, and blanking periods was not effective. As a temporizing solution, the ICD was placed in asynchronous mode, acutely improving the heart rate. The RV lead was revised, resolving the clinical problem. Device-device interactions are rare but can be a result of lead-lead chatter or mechanical interference with other intracardiac devices such as retained fragments, or in this case, a VSD occluder device. As structural interventions become more prevalent, electrophysiologists need to be aware of lead-device interactions.
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