LV loss of capture?

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Dear all,

This periodic EGM was sent from a Biotronik Ilesto HF-T CRT-D. LV pulse amplitude is AUTO 1.8V/0.4ms (common ring bipolar). LV-T wave protection is ON with a maximum trigger rate of 130+20bpm. What is your diagnosis? What programming change do you advise?



Ok, my interpretation:

There is a loss of LV capture (no "evoked response" following the LVp spike, delayed detection (226ms) of the depolarisation coming from the RVp). Just before we see a RV PVC with a 94 ms LV delay of the LV activation. When the LVp is delivered, the LV is still in a natural refractory period: this is a functional loss of LV capture.

What to do?
1) Do not increase the LV pacing output
2) Could be wise to decrease the max trigger rate for LVp (<400ms)
3) Allowing a LVp trigger on PVC, may decrease the refractory period dispersion. This is just theoretical.

Any comment on that?