Hyperglycemia-Induced T-Wave Oversensing as a Cause of Cardiac Resynchronization Therapy (CRT) Failure

• Main Authors: Mohammad Assadian Rad, Zahra Emkanjoo, Hassan Moladoust
• Format: Article
• Language: English
• Published: Tehran University of Medical Sciences 2012-01-01
• Series: Journal of Tehran University Heart Center
• Subjects: Cardiac resynchronization therapy; Cardiac pacing; artficial; Hyperglycemia
• Online Access: https://jthc.tums.ac.ir/index.php/jthc/article/view/238

T-wave oversensing occurs when the counter starts giving dual beeps for every cardiac cycle instead of one. This usually happens when the monitoring lead displays a tall T wave, which is also sharp. R wave sensing algorithms of the devices do not sense T wave because the slow rate of the T wave is much less than that of the R wave. But the slow rate of T waves may change with time and also because of parameters like potassium levels and hyperglycemia. We present a 67-year-old female who underwent the implantation of cardiac resynchronization therapy (cardiac resynchronization and implantable cardioverter defibrilator [CRT-D]) because of severe left ventricular systolic dysfunction and ventricular dyssynchrony experienced recurrent inappropriate implantable cardioverter-defibrillator (ICD) shocks and CRT failure. Device analysis showed that the CRT failure was in consequence of T-wave oversensing due to hyperglycemia. Elimination of the T-wave oversensing after hyperglycemia control conferred  good biventricular pacing and good response to CRT  during a 6-month follow-up period.