A Case of a Cardiac Resynchronization Therapy-Defibrillator Exhibiting a Lower and Alternately Variable Basic Rate
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- Iwazaki Keigo
- Department of Medical Engineering, The University of Tokyo Hospital
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- Kojima Toshiya
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo
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- Murasawa Takahide
- Department of Medical Engineering, The University of Tokyo Hospital
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- Yokota Jun
- Department of Medical Engineering, The University of Tokyo Hospital
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- Tanimoto Hikaru
- Department of Medical Engineering, The University of Tokyo Hospital
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- Matsuda Jun
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo
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- Fukuma Nobuaki
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo
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- Matsubara Takumi
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo
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- Shimizu Yu
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo
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- Oguri Gaku
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo
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- Hasumi Eriko
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo
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- Kubo Hitoshi
- Department of Medical Engineering, The University of Tokyo Hospital
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- Chang Kyungho
- Department of Medical Engineering, The University of Tokyo Hospital
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- Fujiu Katsuhito
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo Department of Ubiquitous Health Informatics, Graduate School of Medicine, The University of Tokyo
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- Komuro Issei
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo
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抄録
<p>A cardiac resynchronization therapy defibrillator (CRT-D) (Medtronic Inc. Protecta XT) was implanted in a 67-year-old man who had cardiac sarcoidosis with extremely low cardiac function. He had ventricular tachycardia which was controlled by catheter ablation, medication and pacing. The programmed mode was DDI, lower rate was 90 beats/minute, paced AV delay was 150 ms, and the noncompetitive atrial pacing (NCAP) function was programmed as 300 ms.</p><p>After his admission for pneumonia and heart failure, we changed his DDI mode to a DDD mode because he had atrial tachycardia, which led to inadequate bi-ventricular pacing. After a while, there were cycle lengths which were longer than his device setting and alternately varied. We were able to avoid this phenomenon with AV delay of 120 ms and NCAP of 200 ms.</p><p>NCAP is an algorithm which creates a gap above a certain period after the detection of an atrial signal during the postventricular atrial refractory period of the pacemaker. This is to prevent atrial tachycardia and repetitive non-reentrant ventriculoatrial (VA) synchrony in the presence of retrograde VA conduction. But in this case, NCAP algorithm induced much lower rate than the programmed basic lower rate. This situation produced some arrhythmias and exacerbated symptoms of heart failure. This had to be paid attention to, especially when the device was programmed at high basic heart rate.</p>
収録刊行物
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- International Heart Journal
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International Heart Journal 59 (3), 626-629, 2018-05-31
一般社団法人 インターナショナル・ハート・ジャーナル刊行会
