Heart Failure Diagnosed by Home Monitoring Tracings | Bordeaux Group
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A 68-year-old male patient who received an implantable cardioverter-defibrillator (ICD) cardiac resynchronization therapy (CRT) presented at an outpatient visit with progressive occurrence of shortness of breath. The internet reports provided by the home monitoring system did not identify any atrial or ventricular arrhythmia, or even any electrical shock.
This patient presents with a stable dilated cardiomyopathy (with wide QRS complexes and left ventricular ejection fraction [LVEF] assessed at 33% by echocardiogram) and documented episodes of ventricular tachycardia, underwent implantation of his ICD CRT two years ago and never presented with sustained ventricular arrhythmia. Physicians have just noticed that he has experienced several asymptomatic short salves of atrial arrhythmias.
During the outpatient visit, his echocardiogram shows worsening heart failure (LVEF at 29%) for the first time.
The memory function of the ICD is interrogated, and only a series of periodic intracardiac electrograms (IEGMs) are mentioned (Figures 1 and 2); this series is analyzed. Table 1 displays the analysis of the periodic IEGM #12.
Which of the following statements describes how one should interpret this tracing report from the home monitoring system?