The Implant for Congestive Heart Failure

Depending on the ICD model biventricular pacing patients may be prone to inappropriate shocks in certain circumstances. There will be more on this phenomenon shortly. Also, it may be difficult in some patients to determine ventricular capture thresholds. Before addressing these issues, however, biventricular programming basics need to be explained. 

5 Patients without chronic AF that receive a CRT ICD will frequently 

Although it has not been extensively studied at present, some patients with chronic AF may receive CRT ICD devices. In these patients the mode is preferably VVIR. Again, since the goal is to pace the ventricles 100% of the time, native conduction to the ventricles in AF needs to be prevented. This is accomplished by providing an adequate lower and upper rate, and utilizing adjunctive AV nodal blocking medicines when needed. In more extreme circumstances the AV node may need to be ablated when medical management cannot control a rapid ventricular response in AF. 

7 Typical CRT ICD pacing parameters in a dual chamber mode include a relatively AV delay and upper rate limit. 

8 The preferable pacing mode in a CRT ICD patient with chronic AF is 

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Simplified Interpretation of ICD Electrograms The Implant for Congestive Heart Failure... 

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