Key result
LBBAP-ICD in AAI mode triggers syncope via pacing inhibition by the VT response algorithm.
Case Report (n=1)
Highlights a potential interaction between device algorithms and pacing configuration that may result in clinically significant pauses in pacing-dependent patients with LBBAP-ICDs programmed in AAI(R) mode.
Clinicians should verify VT Response algorithm settings in LBBAP-ICD upgrades; leaves open need for dedicated conduction system pacing devices.
The lack of dedicated generators for conduction system pacing can force the use of unconventional device configurations in selected patients. We report the case of a 74-year-old pacing-dependent man with non-ischemic cardiomyopathy who underwent an upgrade to LBBAP-ICD, programmed in AAI(R) mode. Syncope occurred after a nonsustained ventricular tachycardia episode due to activation of the Ventricular Tachycardia Response algorithm in a Boston Scientific ICD. This case highlights a potential interaction between device algorithms and pacing configuration that may result in clinically significant pauses in pacing-dependent patients.
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García et al. (2026) conducted a case report in Non-ischemic cardiomyopathy (n=1). LBBAP-ICD programmed in AAI(R) mode was evaluated on Syncope due to pacing inhibition. An LBBAP-ICD programmed in AAI(R) mode caused syncope in a pacing-dependent man due to pacing inhibition by the Ventricular Tachycardia Response algorithm.