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Narayanan K, Sharifzadehgan A, Juin C, Amet D, Swerdlow CD, Marijon E. Inappropriate detection in an implantable cardioverter defibrillator after generator change. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2019; 42:736-738. [PMID: 30874319 DOI: 10.1111/pace.13660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 11/01/2018] [Accepted: 11/01/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Kumar Narayanan
- Paris Cardiovascular Research Centre, Inserm, Paris, France.,Cardiology Department, Maxcure Hospitals, Hyderabad, India
| | - Ardalan Sharifzadehgan
- Paris Cardiovascular Research Centre, Inserm, Paris, France.,Department of Cardiology, European Georges Pompidou Hospital, Paris, France.,Paris Descartes University, Paris, France
| | - Christophe Juin
- Department of Cardiology, European Georges Pompidou Hospital, Paris, France
| | - Denis Amet
- Department of Cardiology, European Georges Pompidou Hospital, Paris, France
| | | | - Eloi Marijon
- Paris Cardiovascular Research Centre, Inserm, Paris, France.,Department of Cardiology, European Georges Pompidou Hospital, Paris, France.,Paris Descartes University, Paris, France
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PLOUX SYLVAIN, SWERDLOW CHARLESD, ESCHALIER ROMAIN, MONTEIL BENJAMIN, OUALI SANA, HAÏSSAGUERRE MICHEL, BORDACHAR PIERRE. Diaphragmatic Myopotential Oversensing Caused by Change in Implantable Cardioverter Defibrillator Sensing Bandpass Filter. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2016; 39:774-778. [DOI: 10.1111/pace.12837] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Accepted: 02/21/2016] [Indexed: 11/29/2022]
Affiliation(s)
- SYLVAIN PLOUX
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux; Université Bordeaux, IHU LIRYC; Bordeaux France
| | - CHARLES D. SWERDLOW
- Cedars-Sinai Heart Institute; Cedars-Sinai Medical Center; Los Angeles California
| | - ROMAIN ESCHALIER
- Image Science for Interventional Techniques (ISIT), UMR6284, and CHU Clermont-Ferrand, Cardiology Department, Clermont Université, Cardio Vascular Interventional Therapy and Imaging (CaVITI); Université d'Auvergne; Clermont-Ferrand France
| | - BENJAMIN MONTEIL
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux; Université Bordeaux, IHU LIRYC; Bordeaux France
| | - SANA OUALI
- Département de Cardiologie; Hôpital La Rabta; Tunis Tunisia
| | - MICHEL HAÏSSAGUERRE
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux; Université Bordeaux, IHU LIRYC; Bordeaux France
| | - PIERRE BORDACHAR
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux; Université Bordeaux, IHU LIRYC; Bordeaux France
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ERDOGAN OKAN, OZBEN BESTE. A Rare Cause of Sensing Integrity Count in a Patient with ICD and Dedicated True Bipolar Lead. Pacing Clin Electrophysiol 2013; 36:1301-5. [DOI: 10.1111/pace.12098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2012] [Revised: 11/20/2012] [Accepted: 12/06/2012] [Indexed: 11/26/2022]
Affiliation(s)
- OKAN ERDOGAN
- From the Department of Cardiology; School of Medicine, Marmara University; Istanbul; Turkey
| | - BESTE OZBEN
- From the Department of Cardiology; School of Medicine, Marmara University; Istanbul; Turkey
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Dorenkamp M, Boldt LH, Blaschke F, Kühnle Y, Haverkamp W, Roser M. Unmasking of myopotential oversensing by an integrated bipolar defibrillator lead following AV node ablation. Herzschrittmacherther Elektrophysiol 2012; 23:131-4. [PMID: 22457167 DOI: 10.1007/s00399-012-0172-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
A 73-year-old man with nonischemic cardiomyopathy underwent catheter ablation of ventricular tachycardia that had resulted in frequent shocks from his implanted cardiac resynchronization therapy defibrillator (CRT-D). Coexisting atrial fibrillation required AV node ablation which rendered the patient pacemaker dependent. During follow-up, recurrent episodes of dizziness occurred caused by inhibition of pacing due to oversensing of pectoral muscle myopotentials. Surgical revision was performed and the intraoperative examination revealed an intact integrated bipolar defibrillator lead with appropriate connections to the CRT-D header. The placement of an additional pace/sense lead completely resolved the patient's symptoms and no further myopotential oversensing was recorded.
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Affiliation(s)
- M Dorenkamp
- Department of Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany
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KACEM SLIM, BECKER GIULIANO, SAVOURÉ ARNAUD, ANSELME FRÉDÉRIC. An Unusual Cause of Syncope in a Patient with an Internal Cardioverter Defibrillator. J Cardiovasc Electrophysiol 2009; 20:699-701. [DOI: 10.1111/j.1540-8167.2008.01406.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Santos KR, Adragao P, Cavaco D, Morgado FB, Candeias R, Lima S, Silva JA. Diaphragmatic myopotential oversensing in pacemaker-dependent patients with CRT-D devices. Europace 2008; 10:1381-6. [DOI: 10.1093/europace/eun241] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Kowalski M, Ellenbogen KA, Wood MA, Friedman PL. Implantable cardiac defibrillator lead failure or myopotential oversensing? An approach to the diagnosis of noise on lead electrograms. Europace 2008; 10:914-7. [DOI: 10.1093/europace/eun167] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Rauwolf T, Guenther M, Hass N, Schnabel A, Bock M, Braun MU, Strasser RH. Ventricular oversensing in 518 patients with implanted cardiac defibrillators: incidence, complications, and solutions. ACTA ACUST UNITED AC 2007; 9:1041-7. [PMID: 17897927 DOI: 10.1093/europace/eum195] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
The present study evaluates the incidence of various complications in implanted cardiac defibrillators (ICD) therapy due to ventricular oversensing (VO) and its complications. From June 1998 to May 2005, we retrospectively screened 518 patients (1085.6 patient years) for the occurrence of VO episodes (441 male, 77 female). The overall incidence was 7.3% (n = 38) with inappropriate shock deliveries accounting for 2.3% (n = 12). All VO episodes were caused by either T-wave oversensing (n = 10), myopotentials (n = 8), electrode failure (n = 5), interference with electromagnetic fields (n = 3), double-counting (n = 4), pacemaker interactions (n = 2), or others (n = 2). There were five life-threatening events due to inappropriate ICD reaction. In eight (22%) cases, ICD reprogramming was able to avoid further oversensing episodes (e.g. adaptation of sensitivity, T-wave suppression feature), 13 (35%) patients had to undergo invasive procedures (e.g. electrode replacing) to suppress VO, 16 (43%) were told to avoid the trigger situation, and one demanded to deactivate all ICD therapies because of inappropriate shock delivery. Our data demonstrate that VO is a rare complication, but might lead to life-threatening events. In most cases, VO episodes could be prevented by appropriate ICD reprogramming or avoidance of the initiating trigger.
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Affiliation(s)
- T Rauwolf
- Medical Clinic II, Department of Internal Medicine and Cardiology, University of Technology Dresden, Fetscherstr. 76, 01307 Dresden, Germany.
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Occhetta E, Bortnik M, Magnani A, Francalacci G, Marino P. Inappropriate implantable cardioverter-defibrillator discharges unrelated to supraventricular tachyarrhythmias. ACTA ACUST UNITED AC 2006; 8:863-9. [PMID: 16916859 DOI: 10.1093/europace/eul093] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
AIMS The development of implantable cardioverter-defibrillators (ICDs) with QRS morphology discrimination and dual-chamber sensing capabilities has improved the differentiation of supraventricular from ventricular tachycardias (VTs). Inappropriate ICD discharges may result from extracardiac signals caused by electromagnetic interference (EMI), because of electric fields and leakage currents from domestic or medical electrical devices, damaged sensing leads, and various cardiac and extracardiac signals that mimic VT and/or ventricular fibrillation. The aim of our study was to determine retrospectively the incidence and clinical relevance of these ICD behaviours and offer possible therapeutic solutions. METHODS AND RESULTS We have observed inappropriate discharges unrelated to supraventricular arrhythmias in 13 (3.9%) of the 336 patients implanted with ICDs in our centre from 1989 to 2005. Seven patients received inappropriate shocks following exposure to external EMI: improperly grounded electric stove, electrically powered watering system, hydro-massage bath, electrical pruner, electrocautery current during cardiac surgery, transcutaneous electric nerve stimulation. In four patients, spurious discharges were related to internal noise of the ICD system from inappropriate lead connections. In two cases, erroneous antitachycardia therapy was delivered following different body signals oversensing (T-wave oversensing, wide QRS double-counting and myopotentials). In nine patients, non-invasive solutions prevented further inappropriate therapies (avoidance of EMI, malfunctioning atrial lead exclusion, ventricular sensing reprogramming). In four patients, surgical revision of the system was required (lead connections or position revision). CONCLUSION In our experience, inappropriate ICD discharges unrelated to supraventricular arrhythmias occurred in about 4% of ICD patients. A careful evaluation of clinical data and telemetric information (lead impedance, sensed R-wave, stored electrograms) is essential in order to understand the nature of inappropriate ICD discharges and to select the most appropriate solution.
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Affiliation(s)
- Eraldo Occhetta
- Divisione Clinicizzata di Cardiologia, Facoltà di Medicina e Chirurgia di Novara, Università degli Studi del Piemonte Orientale, Azienda Ospedaliera Maggiore della Carità, Corso Mazzini 18, 28100 Novara, Italy.
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Saeed M, Jin A, Pontone G, Higgins S, Gold M, Harari D, Nunley S, Link MS, Homoud MK, Estes NAM, Wang PJ. Prevalence of sensing abnormalities in dual chamber implantable cardioverter defibrillators. Ann Noninvasive Electrocardiol 2004; 8:219-26. [PMID: 14510657 PMCID: PMC6932559 DOI: 10.1046/j.1542-474x.2003.08309.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND The clinical efficacy of ICD therapy depends on accurate sensing of intracardiac signals and sensing algorithms. We investigated the occurrence of sensing abnormalities in patients with dual chamber ICDs. METHODS The study group consisted of all patients with dual chamber ICDs enrolled in the LESS trial and patients implanted with dual chamber ICDs at a single center between January 1997 and July 2000. Electrograms of spontaneous ventricular arrhythmias requiring device intervention were analyzed. RESULTS A total of 48 patients met the criteria for enrollment. Among the 244 episodes, 215 (88%) were due to ventricular tachycardia and 29 (12%) were due to ventricular fibrillation. Overall undersensing was infrequent with 12 (20%) patients exhibiting on average 2.2 undersensed beats during 26 episodes of ventricular arrhythmias. There was no delay in therapy due to undersensing. Oversensing occurred in 5 (10%) patients resulting in 13 (2.7%) episodes of inappropriate therapy. None of the patients had any lead abnormalities and oversensing resolved after device reprogramming in 4 patients while 1 patient required a separate rate sensing lead. Among patients with oversensing, 4 out of 5 were pacing before the index event while among patients with no oversensing only 5 out of 42 were pacing (P<0.001). CONCLUSIONS Dual chamber ICDs demonstrate outstanding accuracy of sensing. However, because of the selection of patient population requiring more frequent pacing, oversensing occurs with a significant frequency. Meticulous evaluation in such patients is necessary to minimize the likelihood of oversensing and inappropriate shocks.
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Affiliation(s)
- Mohammad Saeed
- University of Texas Medical Branch, Galveston, TX 77555-0553, USA.
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Weretka S, Michaelsen J, Becker R, Karle CA, Voss F, Hilbel T, Osswald BR, Bahner ML, Senges JC, Kuebler W, Schoels W. Ventricular oversensing: a study of 101 patients implanted with dual chamber defibrillators and two different lead systems. Pacing Clin Electrophysiol 2003; 26:65-70. [PMID: 12685142 DOI: 10.1046/j.1460-9592.2003.00152.x] [Citation(s) in RCA: 84] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
UNLABELLED Modern dual chamber ICD systems are able to overcome various sensing problems. However, improvement of their performance is still required. The aim of this study was to assess the sensing function in 101 consecutive patients (84 men, 17 women; mean age 63 +/- 12 years; mean follow-up 24 +/- 4 months) implanted with dual chamber defibrillators and integrated (IB) or dedicated bipolar (DB) lead systems. Follow-up data were analyzed for the presence of ventricular oversensing. Oversensing occurred in 25 (25%) patients, significantly more frequent in patients implanted with IB compared to DB lead systems (21/52 vs 4/49, P = 0.0002). Patients with cardiomyopathies (CMs) were more prone to sensing malfunctions than patients with no CM (12/30 vs 13/71, P = 0.04). T wave oversensing (n = 14), respirophasic ventricular oversensing (n = 4), and P wave oversensing (n = 6) were the most common pitfalls of ventricular sensing. P wave oversensing was unique to the IB lead system. CT scans performed in these patients disclosed the position of the RV coil to be proximal to the tricuspid area. Four patients received inappropriate ICD shocks due to oversensing. In all but two patients who received lead revision, oversensing was resolved by noninvasive means. IN CONCLUSION (1) ventricular oversensing is a common problem occurring in up to 25% of patients with dual chamber ICDs; (2) P wave oversensing is a ventricular sensing problem affecting function of 11% of dual chamber devices with IB lead systems; (3) IB leads are significantly more susceptible to T wave and P wave oversensing than DB leads; and (4) patients with cardiomyopathies are more prone to oversensing than patients with other heart diseases.
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Affiliation(s)
- Slawomir Weretka
- Department of Cardiology, Electrophysiology, University Hospital Heidelberg, Bergheimerstr. 58, 69115 Heidelberg, Germany.
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Schulte B, Sperzel J, Carlsson J, Dürsch M, Erdogan A, Pitschner HF, Neuzner J. Inappropriate arrhythmia detection in implantable defibrillator therapy due to oversensing of diaphragmatic myopotentials. J Interv Card Electrophysiol 2001; 5:487-93. [PMID: 11752918 DOI: 10.1023/a:1013214516002] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Nonadequate arrhythmia detection and delivery of electrical therapy is still a main problem in current implantable cardioverter defibrillator therapy. Besides supraventricular arrhythmias extra-cardiac biosignals also can cause inadequate shock delivery. The present study focuses on nonadequate arrhythmia detection due to oversensing of diaphragmatic myopotentials. Their clinical characteristics, incidence and management are presented. Three-hundred-eighty-four recipients of a transvenous cardioverter-defibrillator who were implanted and followed-up at our institution between October 1991 and June 1999 were enrolled. During a mean follow-up of 32+/-25 months a total number of 139 nonadequate episodes of arrhythmia detection due to oversensing of diaphragmatic myopotentials were observed in 33 patients (8.6%). In 11 patients a total of 32 high energy shock deliveries occurred. Oversensing of diaphragmatic myopotentials was primarily observed in patients implanted with defibrillator leads providing "integrated bipolar" sensing. The vast majority of nonadequate arrhythmia detection were observed during intrinsic bradycardia heart rate and/or antibradycardia pacing. Electrical lead failure was ruled out in every patient. In 90% of the patients with a cardioverter-defibrillator providing programmable maximal sensitivity (n=16), the reduction of maximum sensitivity was effective in preventing further episodes of nonadequate arrhythmia detection. In 48% of the patients with devices without programmable maximal sensitivity (n=17), surgery revision was necessary to solve the problem.
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Affiliation(s)
- B Schulte
- Kerckhoff Clinic, Department for Cardiology, Bad Nauheim, Germany
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Lee KL, Lau CP. Should all implantable cardioverter defibrillators for ventricular arrhythmias be dual-chamber devices? Curr Cardiol Rep 2001; 3:447-50. [PMID: 11602074 DOI: 10.1007/s11886-001-0065-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The advantages of a dual-chamber implantable cardioverter defibrillator (ICD) over a single-chamber ICD include physiologic pacing capability, atrial electrogram storage, enhanced arrhythmia discrimination algorithms, and a potential to treat atrial arrhythmia by pacing or defibrillation. Current evidence supports the supposition that dual-chamber ICDs are definitely indicated in patients who have a concomitant indication for physiologic pacing, such as bradycardia or bradycardia-dependent ventricular tachyarrhythmias. Refined dual-chamber arrhythmia discrimination algorithms and enhanced atrial therapies are probably required for patients with frequent supraventricular arrhythmias. Furthermore, in patients with systolic heart failure, low ejection fraction, and intraventricular conduction delay, triple-chamber ICDs with biventricular pacing may improve their functional status and prevent sudden arrhythmic death. Careful patient selection is required to optimize the cost-effectiveness of these sophisticated technologies.
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Affiliation(s)
- K L Lee
- University Department of Medicine, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong SAR, PR China
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Abstract
The fifth generation of implantable cardioverter-defibrillators offer enhanced modes of detection of atrial and ventricular arrhythmias, antitachycardia pacing and shocks, multiprogrammability, intracardiac electrogram storage, and all functions of antibradycardia dual-chamber pacing including rate responsiveness and mode switching. There is no consensus on the indications for dual-chamber pacemaker defibrillator systems. This review focuses on the four major options of newer devices that might benefit patients: 1) permanent dual-chamber pacing in ischemic coronary disease patients, 2) detection and management of atrial fibrillation or other atrial tachyarrhythmias, 3) some newer indications for pacing, and 4) the suppression of inappropriate interventions. On the basis of published data, newer indications for the dual-chamber systems, advantages and limitations, and future perspectives are discussed.
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Affiliation(s)
- D Pfeiffer
- Department of Cardiology, Angiology and Hemostaseology, Division of Internal Medicine, University of Leipzig, Johannisallee 32, D-04103 Leipzig, Germany.
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Fan K, Lee K, Lau CP. Dual chamber implantable cardioverter defibrillator benefits and limitations. J Interv Card Electrophysiol 1999; 3:239-45. [PMID: 10490480 DOI: 10.1023/a:1009847707872] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
UNLABELLED Dual chamber ICD capable of providing dual chamber pacing (DDD) and ventricular arrhythmia therapy is now available. We report our experience of clinical performance of dual chamber ICDs amongst Chinese population. METHODS 9 patients (6 men and 3 women) received dual chamber ICDs, mean age 50 +/- 18.8 years. The indications were ventricular fibrillation (VF) [5], hemodynamic intolerant ventricular tachycardia (VT) [3] and unexplained syncope plus positive induction of VF [1]. The underlying cardiac pathology were congenital LQT syndrome(1), hypertrophic cardiomyopathy [2], coronary artery disease [2], rheumatic valvular disease [1], Brugada syndrome [1], arrhythmogenic right ventricular dysplasia [1] and idiopathic VF [1]. Four patients have documented paroxysmal atrial fibrillation (AF). All patients have defibrillation thresholds (DFT) determined with a binary search protocol starting at 12 joules (J) at implantation. RESULTS A total of 34 episodes of VF were induced at implantation with mean DFT 13.8 +/- 7 J. The average shocking impedance was 40 +/- 3.6 Omega. The mean acute P wave measured 3.3 +/- 1.3 mV and R wave measured 13.2 +/- 3.2 mV. Atrial and ventricular thresholds, at pulse width 0.5 ms, averaged 0.8 +/- 0.4 V and 0.4 +/- 0.2 V. During follow-up period, 16 episodes of VF were documented and were successfully treated with the first programmed shock. In the patient with LQT syndrome, DDD was initiated to prevent pause-dependant VF. Three episodes of inappropriate therapy (15.8%) were delivered. One patient experienced 2 shocks after exercise. Stored electrograms showed sinus tachycardia with first degree heart block which was misdiagnosed as VT with retrograde 1:1 conduction. Another inappropriate therapy occurred with AF with fast ventricular response within the VF zone and VT therapy inhibitor was disabled. CONCLUSION Dual chamber ICD allows combined benefits of DDD and VT/VF therapy. Storage of both atrial and ventricular electrograms provide more information in elucidation of nature of dysarrhythmias. Inappropriate shocks, though reduced, are still possible and the rigid algorithms of SVT discrimination from VT will need further published.
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Affiliation(s)
- K Fan
- University Cardiac Medical Unit, Grantham Hospital, Hong Kong, China.
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