A Remote Interrogation requiring further Investigation
Dr Farhana Ara – Specialist ST7 Registrar in Cardiology: Devices and Heart Failure
Sandra Silva – Highly Specialised Cardiac Physiologist
Disclosure: The author has no conflict of interests to declare.
- 81M with previous atrial fibrillation underwent a VVI PPM (Medtronic Vivatron G20A2 SR) implantation for complete heart block. At the post-implant check and six-week in-house device interrogation, the RV threshold was 0.5V@0.4ms.
- The first remote transmission (five months post-implant) showed a gradual increase in threshold from the day of implant.
- The RV threshold was 2.5V@0.4ms and the output was automatically set to 5V@1.0ms.
Lower rate: 60ppm
Upper sensor rate: 130ppm
Pace/Sense polarity: Bipolar/bipolar
Output management: Adaptive
Figure 1: RV lead threshold
What is the next step in management?
(ensure you read answer to question 1 first)