Atrial sensing failure
Tracing
Manufacturer Biotronik
Device PM
Field Sensing
N° 25
Patient
50-year-old man, implanted with an Evia VR pacemaker for sinus dysfunction; recording of a periodic EGM.
Graph and trace
- atrial pacing;
- atrial sensing failure with pacing in the atrial vulnerable period.
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This tracing reveals an intermittent atrial undersensing. P wave sensing has certain peculiarities. Indeed, the amplitude of the sensed atrial signal can vary according to the position of the patient and as a function of the respiratory cycle. It is therefore necessary to set a sufficient margin to avoid atrial undersensing issues during exertion which, in a patient with atrioventricular block, can cause a sudden decrease in the ventricular pacing rate. In addition to the lack of proper monitoring of P waves during exertion, atrial undersensing may have a pro-arrhythmogenic effect if atrial pacing occurs in vulnerable atrial periods with a risk of atrial arrhythmia induction.