Allied Professionals (Non-physician submissions only) -> Teaching Case Reports D-PO01 - Featured Poster Session (ID 11) Poster

D-PO01-048 - Beware The Automated Age: Pitfalls Of Atrial Capture ManagementTmIn Complex Congenital Heart Disease (ID 58)

 A.E. Iams: Nothing relevant to disclose.


Background: Cardiovascular Implantable Electronic Devices (CIED) are often used in unconventional ways in patients with complex congenital heart disease (CHD). Automated device algorithms are not necessarily designed for these situations.
Objective: We demonstrate a case of apparent lack of ventricular output due to use of Atrial Capture ManagementTM in a patient with CHD.
Results: A 31 year old status post Fontan palliation underwent a hybrid epi/endo CRT-P device for sinus node dysfunction and atrioventricular block. Due to abdominal muscle stimulation, the dedicated “RV” lead was programmed at minimum output, functionally resulting in “LV” lead pacing only. During a hospitalization for abdominal surgery, telemetry showed intermittent lack of ventricular output and loss of ventricular capture resulting in atrioventricular block with an escape of 35 bpm (Figure). Testing of both ventricular leads revealed appropriate function and integrity, and no artifact or myopotential noise with isometric exercise. Decreased ventricular lead sensitivity and increased “LV” lead output showed no improvement. Atrial Capture ManagementTM was disabled as the algorithm results in “RV” lead pacing only during testing which had been programmed subthreshold resulting in non-capture. Follow-up monitoring showed no further episodes with normal CIED function.
Conclusion: Using Atrial Capture ManagementTM without adequately programmed “RV” lead outputs can lead to loss of capture. When implanting CIEDs in unconventional scenarios in CHD, hardware choices and programming features must be tailored and thoroughly vetted to determine appropriateness of use in these patients.