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Ross S, Milch A, Kongsgard E. Inappropriate Extravascular ICD Shock Due to Wet Car Seat. JACC Case Rep 2024; 29:102289. [PMID: 38487298 PMCID: PMC10937831 DOI: 10.1016/j.jaccas.2024.102289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 02/07/2024] [Accepted: 02/16/2024] [Indexed: 03/17/2024]
Abstract
Inappropriate shocks from an Intracardiac defibrillator are associated with increased mortality and may be caused by external electromagnetic interference. This case illustrates that water is an excellent conductor of electricity and that determined investigation may reveal the cause of inappropriate shocks.
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Affiliation(s)
- Stian Ross
- Department of Cardiology, Oslo University Hospital, Rikshospitalet, Norway
- University of Oslo, Norway
| | | | - Erik Kongsgard
- Department of Cardiology, Oslo University Hospital, Rikshospitalet, Norway
- University of Oslo, Norway
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2
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Taguchi Y, Ishikawa T, Matsumoto K, Narikawa M, Okazaki Y, Miyagawa S, Horigome A, Hosoda J. Subcutaneous air entrapment after subcutaneous implantable cardioverter defibrillator implantation evaluated by computed tomography. Pacing Clin Electrophysiol 2024; 47:496-502. [PMID: 38462721 DOI: 10.1111/pace.14962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Revised: 01/30/2024] [Accepted: 02/20/2024] [Indexed: 03/12/2024]
Abstract
BACKGROUND Inappropriate shock (IAS) caused by subcutaneous air entrapment (AE) in an early period after subcutaneous implantable cardioverter defibrillator (S-ICD) implantation has been reported, however, no detailed data on air volume are available. We evaluated the subcutaneous air volume after implantation and its absorption rate one week after implantation. METHODS Patients who underwent S-ICD implantation in our hospital received chest CT scans immediately after implantation and followed up 1 week later. The total subcutaneous air volume, air around the generator, the distal electrode, and the proximal electrode within 3 cm were calculated using a three-dimensional workstation. Fat areas at the level of the lower edge of the generator were also analyzed. RESULT Fifteen patients received CT immediately after implantation. The mean age was 45.6 ± 17.9 (66.7% of men), and the mean body mass index was 24.3 ± 3.3. The three-incision technique was applied in seven patients and two-incision technique was in the latter eight patients. The mean total subcutaneous air volume was 18.54 ± 7.50 mL. Air volume around the generator, the distal electrode, and the proximal electrode were 11.05 ± 5.12, 0.72 ± 0.72, and 0.88 ± 0.87 mL, respectively. Twelve patients received a follow-up CT 1 week later. The mean total subcutaneous air was 0.25 ± 0.45 mL, showing a 98.7% absorption rate. CONCLUSION Although subcutaneous air was observed in all patients after S-ICD implantation, most of the air was absorbed within 1 week, suggesting a low occurrence of AE-related IAS after a week postoperation.
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Affiliation(s)
- Yuka Taguchi
- Department of Cardiology, Yokohama City University Graduate School of Medicine, Yokohama-City, Japan
| | - Toshiyuki Ishikawa
- Department of Cardiology, Yokohama City University Graduate School of Medicine, Yokohama-City, Japan
| | - Katsumi Matsumoto
- Department of Cardiology, Yokohama City University Graduate School of Medicine, Yokohama-City, Japan
| | - Masatoshi Narikawa
- Department of Cardiology, Yokohama City University Graduate School of Medicine, Yokohama-City, Japan
| | - Yoshinori Okazaki
- Department of Cardiology, Yokohama City University Graduate School of Medicine, Yokohama-City, Japan
| | - Shuichi Miyagawa
- Department of Cardiology, Yokohama City University Graduate School of Medicine, Yokohama-City, Japan
| | - Akira Horigome
- Department of Cardiology, Yokohama City University Graduate School of Medicine, Yokohama-City, Japan
| | - Junya Hosoda
- Department of Cardiology, Yokohama City University Graduate School of Medicine, Yokohama-City, Japan
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3
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Malaty MM, Ray M, Ferreira D, Morris GM, Jackson N. Intra-Abdominal Hemorrhage Triggering Inappropriate Therapy From a Subcutaneous Defibrillator. JACC Case Rep 2024; 29:102167. [PMID: 38361550 PMCID: PMC10865138 DOI: 10.1016/j.jaccas.2023.102167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 10/30/2023] [Accepted: 11/09/2023] [Indexed: 02/17/2024]
Abstract
The SMART Pass filter (Boston Scientific) aims to reduce inappropriate shocks (IASs) from subcutaneous implantable cardioverter-defibrillators by filtering out low-frequency signals such as T waves. However, this filter is deactivated in the presence of diminished R-wave sensing. We describe a case of IAS in the setting of extensive intra-abdominal hemorrhage.
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Affiliation(s)
- Michael M. Malaty
- Department of Cardiology, John Hunter Hospital, New Lambton, New South Wales, Australia
| | - Max Ray
- Department of Cardiology, John Hunter Hospital, New Lambton, New South Wales, Australia
| | - David Ferreira
- Department of Cardiology, John Hunter Hospital, New Lambton, New South Wales, Australia
- School of Medicine, University of Newcastle, New South Wales, Australia
| | - Gwilym M. Morris
- Department of Cardiology, John Hunter Hospital, New Lambton, New South Wales, Australia
- School of Medicine, University of Newcastle, New South Wales, Australia
- Hunter Medical Research Institute, New Lambton, New South Wales, Australia
| | - Nicholas Jackson
- Department of Cardiology, John Hunter Hospital, New Lambton, New South Wales, Australia
- School of Medicine, University of Newcastle, New South Wales, Australia
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Okazaki M, Sahashi Y, Nagase T, Inoue K, Sekiguchi Y, Nitta J, Shinoda S, Shimizu S, Kuroki M, Isobe M, Mihara T. Inappropriate shock incidence in patients with subcutaneous implantable cardioverter-defibrillators with concomitant cardiac implantable electronic devices: A single-center cohort study. Pacing Clin Electrophysiol 2024; 47:131-138. [PMID: 38010718 DOI: 10.1111/pace.14887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 10/08/2023] [Accepted: 11/15/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND Subcutaneous implantable cardioverter defibrillators (S-ICDs) are occasionally used in combination with other cardiac implantable electronic devices (CIEDs). However, whether the incidence of inappropriate shock increases in patients with S-ICDs and concomitant CIEDs remains unclear. This study aimed to investigate the association between the concomitant use of CIEDs and the incidence of inappropriate shock in patients with current-generation S-ICDs. METHODS A total of 127 consecutive patients received an S-ICD. Patients were assigned to two groups depending on concomitant use of CIEDs at the time of S-ICD implantation: patients without other CIEDs (non-combined group, 106 patients) and patients with other CIEDs (combined group, 21 patients). CIEDs included pacemakers, implantable cardioverter defibrillators, cardiac resynchronization therapy pacemakers, and cardiac resynchronization therapy defibrillators. The primary outcome was inappropriate shock, defined as a shock other than ventricular arrhythmia. Hazard ratios and 95% confidence intervals were calculated using a time-varying Cox proportional hazards model which was adjusted for age because age differed between the groups and could be a confounder. RESULTS During a median follow-up period of 2.2 years (interquartile range, 1.0-3.4 years), inappropriate shock events occurred in 17 (16%) and five (19%) patients of the non-combined and combined groups, respectively. While the age-adjusted hazard ratio for inappropriate shock was 24% higher in the combined than in the non-combined group (hazard ratio = 1.24, 95% confidence interval, 0.39-3.97), this difference was insignificant (p = .71). CONCLUSION The incidence of inappropriate shock did not differ between patients with and without concomitant use of CIEDs, suggesting that S-ICDs could potentially be combined with other CIEDs without increasing the number of inappropriate shocks. Further studies are warranted to confirm the safety and feasibility of concomitant use of S-ICDs and CIEDs.
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Affiliation(s)
- Makiko Okazaki
- Department of Clinical Engineering, Sakakibara Heart Institute, Fuchu-shi, Tokyo, Japan
- Department of Health Data Science, Yokohama City University Graduate School of Data Science, Yokohama-shi, Kanagawa, Japan
| | - Yuki Sahashi
- Department of Cardiology, Gifu University Graduate School of Medicine, Gifu-shi, Japan
| | - Takahiko Nagase
- Department of Cardiology, Sakakibara Heart Institute, Fuchu-shi, Tokyo, Japan
| | - Kanki Inoue
- Department of Cardiology, Sakakibara Heart Institute, Fuchu-shi, Tokyo, Japan
| | - Yukio Sekiguchi
- Department of Cardiology, Sakakibara Heart Institute, Fuchu-shi, Tokyo, Japan
| | - Junichi Nitta
- Department of Cardiology, Sakakibara Heart Institute, Fuchu-shi, Tokyo, Japan
| | - Satoru Shinoda
- Department of Biostatistics, School of Medicine, Yokohama City University, Yokohama-shi, Kanagawa, Japan
| | - Sayuri Shimizu
- Department of Health Data Science, Yokohama City University Graduate School of Data Science, Yokohama-shi, Kanagawa, Japan
| | - Makoto Kuroki
- Department of Health Data Science, Yokohama City University Graduate School of Data Science, Yokohama-shi, Kanagawa, Japan
| | | | - Takahiro Mihara
- Department of Health Data Science, Yokohama City University Graduate School of Data Science, Yokohama-shi, Kanagawa, Japan
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Budrejko S, Zienciuk-Krajka A, Olędzki S, Daniłowicz-Szymanowicz L, Kempa M. How likely is the sense-B-noise to affect patients with subcutaneous implantable cardioverter-defibrillators and can we solve that problem in every case? Pacing Clin Electrophysiol 2023; 46:1472-1477. [PMID: 37864812 DOI: 10.1111/pace.14853] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 10/02/2023] [Accepted: 10/10/2023] [Indexed: 10/23/2023]
Abstract
BACKGROUND Sense-B-noise is a newly reported possible cause of inappropriate shocks in patients with subcutaneous implantable cardioverter-defibrillators (S-ICDs). The nature of that noise is unknown, it is not related to mechanical failure of the S-ICD system. Reprogramming to the secondary sensing vector is suggested by the producer as a possible solution. METHODS We analyzed the medical records of S-ICD recipients from two university clinical centers (Gdansk and Szczecin, Poland). Our aim was to determine the rate of sense-B-noise, and whether the secondary sensing vector would be available for reprogramming if such a problem occurred in our patients. RESULTS The sense-B-noise issue affected three patients in our cohort (3%), which corresponds to the incidence of 0.012 events per patient-year of follow-up. The primary vector was permanently used in 47 patients (52%), secondary in 28 (31%), and alternate in 16 (17%), respectively. Therefore, the total number of patients potentially vulnerable to sense-B noise (with the primary or alternate vector programmed permanently) was 63 (69%). Among those 63 patients, 51 individuals (81%) had also the secondary vector available for permanent use. CONCLUSION The sense-B-noise affected 3% of patients in our cohort, with an incidence of 0.012 per patient-year of follow-up. Most patients potentially vulnerable to sense-B noise could be reprogrammed to the secondary sensing vector, if necessary. Further investigation of the sense-B-noise issue is needed.
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Affiliation(s)
- Szymon Budrejko
- Department of Cardiology and Electrotherapy, Faculty of Medicine, Medical University of Gdansk, Gdansk, Poland
| | - Agnieszka Zienciuk-Krajka
- Department of Cardiology and Electrotherapy, Faculty of Medicine, Medical University of Gdansk, Gdansk, Poland
| | - Szymon Olędzki
- Department of Cardiology, Pomeranian Medical University in Szczecin, Szczecin, Poland
| | | | - Maciej Kempa
- Department of Cardiology and Electrotherapy, Faculty of Medicine, Medical University of Gdansk, Gdansk, Poland
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Okada T, Morita J, Kitai T, Fujita T, Kondo Y. Oversensing caused by trapped air in the header of subcutaneous cardioverter-defibrillator generator. J Arrhythm 2023; 39:803-806. [PMID: 37799797 PMCID: PMC10549796 DOI: 10.1002/joa3.12912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 07/19/2023] [Accepted: 08/09/2023] [Indexed: 10/07/2023] Open
Abstract
In this study, we report two cases with oversensing due to air accumulation in the subcutaneous implantable cardioverter-defibrillator (S-ICD) device generator header. If trapped air in the header of the device is suspected, the re-connection procedure should be considered or the primary vector must be used, which might prevent oversensing.
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Affiliation(s)
- Takuya Okada
- Department of Clinical Engineering, Sapporo Heart CenterSapporo Cardiovascular ClinicSapporoJapan
| | - Junji Morita
- Department of Cardiovascular Medicine, Sapporo Heart CenterSapporo Cardiovascular ClinicSapporoJapan
| | - Takayuki Kitai
- Department of Cardiovascular Medicine, Sapporo Heart CenterSapporo Cardiovascular ClinicSapporoJapan
| | - Tsutomu Fujita
- Department of Cardiovascular Medicine, Sapporo Heart CenterSapporo Cardiovascular ClinicSapporoJapan
| | - Yusuke Kondo
- Department of Cardiovascular MedicineChiba University Graduate School of MedicineChibaJapan
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7
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Russo V, Ciabatti M, Brunacci M, Dendramis G, Santobuono V, Tola G, Picciolo G, Teresa LM, D'Andrea A, Nesti M. Opportunities and drawbacks of the subcutaneous defibrillator across different clinical settings. Expert Rev Cardiovasc Ther 2023; 21:151-164. [PMID: 36847583 DOI: 10.1080/14779072.2023.2184350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
INTRODUCTION The subcutaneous implantable cardioverter-defibrillator (S-ICD) is an established therapy for the prevention of sudden cardiac death (SCD) and an alternative to a transvenous implantable cardioverter-defibrillator system in selected patients. Beyond randomized clinical trials, many observational studies have described the clinical performance of S-ICD across different subgroups of patients. AREAS COVERED Our review aimed to describe the opportunities and drawbacks of the S-ICD, focusing on their use in special populations and across different clinical settings. EXPERT OPINION The choice to implant S-ICD should be based on the patient's tailored approach, which takes into account the adequate S-ICD screening at rest or during stress, the infective risk, the ventricular arrhythmia susceptibility, the progressive nature of the underlying disease, the work or sports activity, and the risk of lead-related complications.
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Affiliation(s)
- Vincenzo Russo
- Cardiology Unit, University of Campania 'Luigi Vanvitelli' - Monaldi Hospital, Naples, Italy
| | | | | | | | | | | | | | | | | | - Martina Nesti
- Cardiology Unit, San Donato Hospital, Arezzo (FI), Italy
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8
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Stegemann E, Weidmann M, Miyazawa AA, Shun-Shin MJ, Leyva F, Zegard A, Stegemann B. Laser Doppler flow for the hemodynamic differentiation of tachycardia. Pacing Clin Electrophysiol 2023; 46:114-124. [PMID: 36385259 DOI: 10.1111/pace.14618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 09/15/2022] [Accepted: 10/31/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Implantable cardioverter defibrillators (ICDs) offer effective therapy for the prevention of sudden cardiac death (SCD) due to ventricular arrhythmias. However, inappropriate shocks have detrimental effects on survival and quality of life. The addition of hemodynamic monitoring may be useful in discriminating clinically important ventricular arrhythmias. OBJECTIVE In this study, we assess the ability of laser Doppler flowmetry to assess the hemodynamic effect of paced atrial and ventricular arrhythmias using mean arterial blood pressure as the reference. METHODS In this acute human study in patients undergoing an elective electrophysiological study, laser Doppler flowmetry, arterial blood pressure, and surface ECG were acquired during high-rate atrial and ventricular pacing to simulate supraventricular and ventricular tachycardias. RESULTS Arterial blood pressure and laser Doppler flow signals correlated well during atrial and ventricular pacing (rho = 0.694, p < .001). The hemodynamic impairment detected by both methods was greater during ventricular pacing than atrial pacing (-1.0% vs. 19.0%, p < .001). Laser Doppler flowmetry performed better than rate alone to identify hemodynamic impairments. CONCLUSION In this acute study, laser Doppler flowmetry tissue perfusion served as a good surrogate measure for arterial pressure, which could be incorporated into future ICDs.
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Affiliation(s)
- Emilia Stegemann
- Clinic for Internal Medicine & Angiology, Agaplesion Diakonie Kliniken Kassel, Kassel, Germany.,Klinik für Kardiologie und Angiologie, Medizinische Fakultät der Philipps-Universität Marburg, Marburg, Germany
| | - Mia Weidmann
- Medizinische Klinik II, Klinikum Kassel, Kassel, Germany
| | - Alejandra A Miyazawa
- National Heart and Lung Institute, Imperial College London, Hammersmith Hospital, United Kingdom
| | - Matthew J Shun-Shin
- National Heart and Lung Institute, Imperial College London, Hammersmith Hospital, United Kingdom
| | - Francisco Leyva
- Aston Medical School, Aston University, Birmingham, United Kingdom.,Queen Elizabeth Hospital, Birmingham, United Kingdom
| | - Abbasin Zegard
- Aston Medical School, Aston University, Birmingham, United Kingdom.,Queen Elizabeth Hospital, Birmingham, United Kingdom
| | - Berthold Stegemann
- National Heart and Lung Institute, Imperial College London, Hammersmith Hospital, United Kingdom.,Aston Medical School, Aston University, Birmingham, United Kingdom.,Queen Elizabeth Hospital, Birmingham, United Kingdom
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Vetta G, Parlavecchio A, Magnocavallo M, Valente D, Caminiti R, Polselli M, Vetta F, Cirone D, Cauti FM, Crea P, Rossi P, Chierchia GB, Bianchi S, de Asmundis C, Natale A, Della Rocca DG. Subcutaneous versus transvenous implantable cardioverter defibrillators in children and young adults: A meta-analysis. Pacing Clin Electrophysiol 2022; 45:1409-1414. [PMID: 36214206 DOI: 10.1111/pace.14603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 09/20/2022] [Accepted: 09/27/2022] [Indexed: 12/13/2022]
Abstract
INTRODUCTION The implantable cardioverter defibrillator (ICD) has been demonstrated to successfully prevent sudden cardiac death (SCD) in children and young adults. A wide range of device-related complications/malfunctions have been described, which depend on the intrinsic design of the defibrillation system (transvenous-implantable cardioverter defibrillator [TV-ICD] vs. subcutaneous-implantable cardioverter defibrillator [S-ICD]). OBJECTIVE To compare the device-related complications and inappropriate shocks with TV-ICD versus S-ICD. METHODS AND RESULTS Electronic databases were queried for studies focusing on the prevention of SCD in children and young adults with TV-ICD or S-ICD. The effect size was estimated using a random-effect model as odds ratio (OR) and relative 95% confidence interval (CI). The primary endpoint was a composite of any device-related complications and inappropriate shocks. We identified a total of five studies including 236 patients (Group S-ICD: 76 patients; Group TV-ICD: 160 patients) with a mean follow-up time of 54.2 ± 24.9 months. S-ICD implantation contributed to a significant reduction in the risk of the primary endpoint of any device-related complications and inappropriate shocks (OR: 0.18; 95% CI: 0.05-0.73; p = .02). S-ICD was also associated with a significantly lower incidence of inappropriate shocks (OR: 0.28; 95% CI: 0.11-0.74; p = .01) and lead-related complications (OR: 0.18; 95% CI: 0.05-0.66; p = .01). A trend toward a higher risk of pocket complications (OR: 5.91; 95% CI: 0.98-35.63; p = .05) was recorded in patients with S-ICD. CONCLUSION Children and young adults undergoing S-ICD implantation may have a lower risk of a composite of device-related complications and inappropriate shocks, compared to TV-ICD patients.
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Affiliation(s)
- Giampaolo Vetta
- Cardiology Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Antonio Parlavecchio
- Cardiology Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Michele Magnocavallo
- Cardiology Division, Arrhythmology Unit, S. Giovanni Calibita Hospital, Isola Tiberina, Rome, Italy
| | - Debora Valente
- Maternal-Infantile and Urological Science Department, "Sapienza" University of Rome, Rome, Italy
| | - Rodolfo Caminiti
- Cardiology Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Marco Polselli
- Cardiology Division, Arrhythmology Unit, S. Giovanni Calibita Hospital, Isola Tiberina, Rome, Italy
| | | | | | - Filippo Maria Cauti
- Cardiology Division, Arrhythmology Unit, S. Giovanni Calibita Hospital, Isola Tiberina, Rome, Italy
| | - Pasquale Crea
- Cardiology Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Pietro Rossi
- Cardiology Division, Arrhythmology Unit, S. Giovanni Calibita Hospital, Isola Tiberina, Rome, Italy
| | - Gian Battista Chierchia
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium
| | - Stefano Bianchi
- Cardiology Division, Arrhythmology Unit, S. Giovanni Calibita Hospital, Isola Tiberina, Rome, Italy
| | - Carlo de Asmundis
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA
| | - Domenico Giovanni Della Rocca
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium.,Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA
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10
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Iavarone M, Rago A, Nigro G, Golino P, Russo V. Inappropriate shocks due to air entrapment in patients with subcutaneous implantable cardioverter-defibrillator: a meta-summary of case reports. Pacing Clin Electrophysiol 2022; 45:1210-1215. [PMID: 35983947 PMCID: PMC10108567 DOI: 10.1111/pace.14584] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 07/12/2022] [Accepted: 07/20/2022] [Indexed: 11/30/2022]
Abstract
Air entrapment has been recently described as a cause of inappropriate shock (IAS) among patients who underwent subcutaneous implantable cardioverter-defibrillator (S-ICD) implantation. Data about this complication are lacking in the literature. This meta-summary aimed to collect the case reports describing IAS due to air entrapment, evaluate the possible promoting factors and elaborate a practical approach for prevention, diagnosis, and management of this complication. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Michele Iavarone
- Cardiology Unit, Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli" - Monaldi Hospital, Naples, Italy
| | - Anna Rago
- Cardiology Unit, Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli" - Monaldi Hospital, Naples, Italy
| | - Gerardo Nigro
- Cardiology Unit, Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli" - Monaldi Hospital, Naples, Italy
| | - Paolo Golino
- Cardiology Unit, Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli" - Monaldi Hospital, Naples, Italy
| | - Vincenzo Russo
- Cardiology Unit, Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli" - Monaldi Hospital, Naples, Italy
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11
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Bisignani A, Conte G, Pannone L, Sieira J, Del Monte A, Lipartiti F, Bala G, Miraglia V, Monaco C, Ströker E, Overeinder I, Almorad A, Gauthey A, Franchetti Pardo L, Raes M, Detriche O, Brugada P, Auricchio A, Chierchia GB, de Asmundis C. Long-Term Outcomes of Pulmonary Vein Isolation in Patients With Brugada Syndrome and Paroxysmal Atrial Fibrillation. J Am Heart Assoc 2022; 11:e026290. [PMID: 35862178 PMCID: PMC9375506 DOI: 10.1161/jaha.122.026290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Pharmacological treatment of atrial fibrillation (AF) in the setting of Brugada syndrome (BrS) is challenging. In addition, patients with BrS with an implantable cardioverter-defibrillator (ICD) might experience inappropriate shocks for fast AF. Long-term outcome of pulmonary vein isolation in BrS has not been well established yet, and it is still unclear whether pulmonary vein triggers are the only pathophysiological mechanism of AF in BrS. The aim of the study is to assess the long-term outcomes in patients with BrS undergoing pulmonary vein isolation for paroxysmal AF compared with a matched cohort of patients without BrS. Methods and Results Sixty patients with BrS undergoing pulmonary vein isolation with cryoballoon catheter ablation for paroxysmal AF were matched with 60 patients without BrS, who underwent the same procedure. After a mean follow-up of 58.2±31.7 months, freedom from atrial tachyarrhythmias was achieved in 61.7% in the BrS group and in 78.3% in the non-BrS group (log-rank P=0.047). In particular, freedom from AF was 76.7% in the first group and in 83.3% in the second (P=0.27), while freedom from atrial tachycardia/atrial flutter was 85% and 95% (P=0.057). In the BrS group, 29 patients (48.3%) had an ICD and 8 (27.6%) had a previous ICD-inappropriate shock for fast AF. In the BrS cohort, ICD-inappropriate interventions for AF were significantly reduced after ablation (3.4% versus 27.6%; P=0.01). Conclusions Pulmonary vein isolation in patients with BrS was associated with higher rate of arrhythmic recurrence. Despite this, catheter ablation significantly reduced inappropriate ICD interventions in BrS patients and can be considered a therapeutic strategy to prevent inappropriate device therapies.
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Affiliation(s)
- Antonio Bisignani
- Postgraduate Program in Cardiac Electrophysiology and Pacing, Heart Rhythm Management Centre, European Reference Networks Guard-Heart Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel Brussels Belgium.,Institute of Cardiology Università Cattolica del Sacro Cuore Rome Italy
| | - Giulio Conte
- Division of Cardiology Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale Lugano Switzerland
| | - Luigi Pannone
- Postgraduate Program in Cardiac Electrophysiology and Pacing, Heart Rhythm Management Centre, European Reference Networks Guard-Heart Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel Brussels Belgium
| | - Juan Sieira
- Postgraduate Program in Cardiac Electrophysiology and Pacing, Heart Rhythm Management Centre, European Reference Networks Guard-Heart Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel Brussels Belgium
| | - Alvise Del Monte
- Postgraduate Program in Cardiac Electrophysiology and Pacing, Heart Rhythm Management Centre, European Reference Networks Guard-Heart Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel Brussels Belgium
| | - Felicia Lipartiti
- Postgraduate Program in Cardiac Electrophysiology and Pacing, Heart Rhythm Management Centre, European Reference Networks Guard-Heart Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel Brussels Belgium
| | - Gezim Bala
- Postgraduate Program in Cardiac Electrophysiology and Pacing, Heart Rhythm Management Centre, European Reference Networks Guard-Heart Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel Brussels Belgium
| | - Vincenzo Miraglia
- Postgraduate Program in Cardiac Electrophysiology and Pacing, Heart Rhythm Management Centre, European Reference Networks Guard-Heart Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel Brussels Belgium
| | - Cinzia Monaco
- Postgraduate Program in Cardiac Electrophysiology and Pacing, Heart Rhythm Management Centre, European Reference Networks Guard-Heart Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel Brussels Belgium
| | - Erwin Ströker
- Postgraduate Program in Cardiac Electrophysiology and Pacing, Heart Rhythm Management Centre, European Reference Networks Guard-Heart Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel Brussels Belgium
| | - Ingrid Overeinder
- Postgraduate Program in Cardiac Electrophysiology and Pacing, Heart Rhythm Management Centre, European Reference Networks Guard-Heart Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel Brussels Belgium
| | - Alexandre Almorad
- Postgraduate Program in Cardiac Electrophysiology and Pacing, Heart Rhythm Management Centre, European Reference Networks Guard-Heart Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel Brussels Belgium
| | - Anaïs Gauthey
- Postgraduate Program in Cardiac Electrophysiology and Pacing, Heart Rhythm Management Centre, European Reference Networks Guard-Heart Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel Brussels Belgium
| | - Livia Franchetti Pardo
- Division of Cardiology Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale Lugano Switzerland
| | - Matthias Raes
- Anaesthesiology Department Vrije Universiteit Brussel Brussels Belgium
| | - Olivier Detriche
- Anaesthesiology Department Vrije Universiteit Brussel Brussels Belgium
| | - Pedro Brugada
- Postgraduate Program in Cardiac Electrophysiology and Pacing, Heart Rhythm Management Centre, European Reference Networks Guard-Heart Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel Brussels Belgium
| | - Angelo Auricchio
- Division of Cardiology Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale Lugano Switzerland
| | - Gian-Battista Chierchia
- Postgraduate Program in Cardiac Electrophysiology and Pacing, Heart Rhythm Management Centre, European Reference Networks Guard-Heart Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel Brussels Belgium
| | - Carlo de Asmundis
- Postgraduate Program in Cardiac Electrophysiology and Pacing, Heart Rhythm Management Centre, European Reference Networks Guard-Heart Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel Brussels Belgium
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12
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Babic MD, Tomovic M, Milosevic M, Djurdjevic B, Zugic V, Nikolic A. Inappropriate shock delivery as a result of electromagnetic interference originating from the faulty electrical installation. Ann Noninvasive Electrocardiol 2022; 27:e12952. [PMID: 35467789 PMCID: PMC9484028 DOI: 10.1111/anec.12952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 03/22/2022] [Indexed: 11/30/2022] Open
Abstract
We present a case report of a 74‐year‐old male patient with an implantable cardioverter defibrillator who suffered an inappropriate defibrillation shock while bathing in the tub. Insight in the ICD stored electrogram episodes revealed electromagnetic interferences, with a typical 50 Hz electrical artifact mimicking fast ventricular tachycardia as a device misinterpreted. After this event, the maintenance workers investigated the electrical installation in the bathroom and revealed that there was voltage leaking between electrical installation and metal pipes. After the repair was completed without any additional programming, the patient has had no subsequent shocks.
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Affiliation(s)
- Milos D Babic
- Institute for Cardiovascular Diseases Dedinje, Belgrade, Serbia
| | - Milosav Tomovic
- Institute for Cardiovascular Diseases Dedinje, Belgrade, Serbia
| | - Maja Milosevic
- Institute for Cardiovascular Diseases Dedinje, Belgrade, Serbia
| | | | - Vasko Zugic
- Institute for Cardiovascular Diseases Dedinje, Belgrade, Serbia
| | - Aleksandra Nikolic
- Institute for Cardiovascular Diseases Dedinje, Belgrade, Serbia.,School Of Medicine, University of Belgrade, Belgrade, Serbia
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13
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Bissolino A, Andreis A, Magnano M, Budano C, Saglietto A, Angelini F, Roagna E, Mattivi S, Peyracchia M, Errigo D, Golzio PG, Castagno D, Giustetto C, De Ferrari GM. Prognostic role of left atrial enlargement in patients with implantable cardioverter defibrillators for primary prevention. Acta Cardiol 2022; 77:45-50. [PMID: 33308049 DOI: 10.1080/00015385.2020.1856491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PURPOSE Left atrial volume index (LAVI) is a predictor of heart failure and adverse events, irrespective of left ventricular systolic function. The role of LAVI in the prediction of appropriate implantable cardioverter-defibrillator (ICD) therapies is currently unclear and was the focus of this study. METHODS Consecutive heart failure patients with ischaemic (ICM) or idiopathic (DCM) aetiology receiving ICD for primary prevention were included. The primary endpoint was the occurrence of appropriate ICD therapies (ATs): shocks or antitachycardia pacing (ATP). Inappropriate ICD shocks were also assessed as secondary endpoint. RESULTS Among 198 included patients, severe left atrial dilatation (SLAE = LAVI ≥ 60 ml/m2) was present in 54 (27%). SLAE patients had a higher prevalence of NYHA class ≥ III, severe mitral regurgitation and atrial fibrillation history. During a median follow-up of 45 months (IQR 25-68), ATs occurred more frequently in SLAE group (33% vs. 15%, p = .007) as well as appropriate shocks (24% vs. 10%, p = .014). At multivariate analysis SLAE was an independent predictor of ATs (OR 3.19, 95% CI 1.38-7.38, p = .007). Inappropriate shocks were associated with AF during implantation (p = .03), but not with SLAE (p = .009). CONCLUSION In DCM or ICM patients candidate to receive an ICD for primary prevention, a severely enlarged left atrium is a predictive factor for ATs (shocks or ATP). The risk of inappropriate shocks was increased in patients with atrial fibrillation, rather than SLAE.
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Affiliation(s)
- Arianna Bissolino
- Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza di Torino Hospital, Turin, Italy
| | - Alessandro Andreis
- Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza di Torino Hospital, Turin, Italy
| | - Massimo Magnano
- Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza di Torino Hospital, Turin, Italy
| | - Carlo Budano
- Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza di Torino Hospital, Turin, Italy
| | - Andrea Saglietto
- Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza di Torino Hospital, Turin, Italy
| | - Filippo Angelini
- Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza di Torino Hospital, Turin, Italy
| | - Edoardo Roagna
- Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza di Torino Hospital, Turin, Italy
| | - Simone Mattivi
- Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza di Torino Hospital, Turin, Italy
| | - Mattia Peyracchia
- Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza di Torino Hospital, Turin, Italy
| | - Daniele Errigo
- Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza di Torino Hospital, Turin, Italy
| | - Pier Giorgio Golzio
- Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza di Torino Hospital, Turin, Italy
| | - Davide Castagno
- Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza di Torino Hospital, Turin, Italy
| | - Carla Giustetto
- Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza di Torino Hospital, Turin, Italy
| | - Gaetano Maria De Ferrari
- Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza di Torino Hospital, Turin, Italy
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14
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Gulumser Sisko S, Kafali HC, Ergul Y. Inappropriate shock delivery by an implantable cardioverter-defibrillator due to electrical interference with a refrigerator in a 4-year-old child. Cardiol Young 2021; 32:1-3. [PMID: 34551848 DOI: 10.1017/s104795112100370x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
We report a patient with long QT syndrome who received an inappropriate implantable cardioverter-defibrillator shock due to electrical interference from a refrigerator. This electrical interference was mistakenly detected as an episode of ventricular fibrillation and ended with an inappropriate delivery of shock without any warning symptoms before.
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Affiliation(s)
- Sezen Gulumser Sisko
- Department of Pediatric Cardiology, University of Health Sciences, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Hasan Candas Kafali
- Department of Pediatric Cardiology, University of Health Sciences, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Yakup Ergul
- Department of Pediatric Cardiology, University of Health Sciences, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
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15
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Casu G, Silva E, Bisbal F, Viola G, Merella P, Lorenzoni G, Motta G, Bandino S, Berne P. Predictors of inappropriate shock in Brugada syndrome patients with a subcutaneous implantable cardiac defibrillator. J Cardiovasc Electrophysiol 2021; 32:1704-1711. [PMID: 33928706 DOI: 10.1111/jce.15059] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 03/23/2021] [Accepted: 04/19/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Subcutaneous implantable cardioverter defibrillators (S-ICDs) avoid complications secondary to transvenous leads, but inappropriate shocks (ISs) are frequent. Furthermore, IS data from patients with Brugada syndrome (BrS) with an S-ICD are scarce. OBJECTIVE We aimed to establish the frequency and predictors of IS in this population. METHODS We analyzed the clinical and electrocardiographic characteristics, automated screening test data, device programming, and IS occurrence in adult patients with BrS with an S-ICD. RESULTS Thirty-nine patients were enrolled (69% male, mean age at diagnosis 46 ± 13 years, mean age at implantation 48 ± 13 years). During a mean follow-up of 26 ± 21 months, 18% patients experienced IS. Patients with IS were younger at the time of diagnosis (36 ± 8 vs. 48 ± 13 years, p = .018) and S-ICD implantation (38 ± 9 vs. 50 ± 23 years, p = .019) and presented with spontaneous type 1 Brugada electrocardiogram pattern more frequently at diagnosis or during follow-up (71% vs. 25%, p = .018). During automated screening tests, patients with IS showed lower QRS voltage in the primary vector in the supine position (0.58 ± 0.26 vs. 1.10 ± 0.35 mV, p = .011) and lower defibrillator automated screening score in the primary vector in the supine (123 ± 165 vs. 554 ± 390 mV, p = .005) and standing (162 ± 179 vs. 486 ± 388 mV, p = .038) positions. Age at diagnosis was the only independent predictor of IS (hazard ratio = 0.873, 95% confidence interval: 0.767-0.992, p = .037). CONCLUSION IS was a frequent complication in patients with BrS with an S-ICD. Younger age was independently associated with IS. A more thorough screening process might help prevent IS in this population.
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Affiliation(s)
- Gavino Casu
- Cardiology Department, Ospedale San Francesco, Nuoro, Italy.,Biomedical Science PhD Course, University of Sassari, Sassari, Italy
| | - Etelvino Silva
- Hospital Universitario Puerta del Mar, Cadiz, Spain.,Instituto de Investigación e Innovación Biomédica de Cádiz (INiBICA), Grupo GADICOR, Hospital Universitario Puerta del Mar, Universidad de Cádiz, Cádiz, Spain
| | - Felipe Bisbal
- Heart Institute (iCor), University Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain.,CIBERCV, Instituto de Salud Carlos III, Madrid, Spain
| | - Graziana Viola
- Cardiology Department, Ospedale San Francesco, Nuoro, Italy
| | | | | | - Giovanni Motta
- Cardiology Department, Ospedale San Francesco, Nuoro, Italy
| | | | - Paola Berne
- Cardiology Department, Ospedale San Francesco, Nuoro, Italy
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16
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Briongos-Figuero S, García-Alberola A, Rubio J, Segura JM, Rodríguez A, Peinado R, Alzueta J, Martínez-Ferrer JB, Viñolas X, Fernández de la Concha J, Anguera I, Martín M, Cerdá L, Pérez L. Long-Term Outcomes Among a Nationwide Cohort of Patients Using an Implantable Cardioverter-Defibrillator: UMBRELLA Study Final Results. J Am Heart Assoc 2020; 10:e018108. [PMID: 33356406 PMCID: PMC7955463 DOI: 10.1161/jaha.120.018108] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Large‐scale studies describing modern populations using an implantable cardioverter‐defibrillator (ICD) are lacking. We aimed to analyze the incidence of arrhythmia, device interventions, and mortality in a broad spectrum of real‐world ICD patients with different heart disorders. Methods and Results The UMBRELLA study is a prospective, multicenter, nationwide study of contemporary patients using an ICD followed up by remote monitoring, with a blinded review of arrhythmic episodes. From November 2005 to November 2017, 4296 patients were followed up. After 46.6±27.3 months, 16 067 episodes of sustained ventricular arrhythmia occurred in 1344 patients (31.3%). Appropriate ICD therapy occurred in 27.3% of study population. Patients with ischemic cardiomyopathy (hazard ratio [HR], 1.51; 95% CI, 1.29–1.78), dilated cardiomyopathy (HR, 1.28; 95% CI, 1.07–1.53), and valvular heart disease (HR, 1.94; 95% CI, 1.43–2.62) exhibited a higher risk of appropriate ICD therapies, whereas patients with hypertrophic cardiomyopathy (HR, 0.72; 95% CI, 0.54–0.96) and Brugada syndrome (HR, 0.25; 95% CI, 0.14–0.45) showed a lower risk. All‐cause death was 13.4% at follow‐up. Ischemic cardiomyopathy (HR, 3.09; 95% CI, 2.58–5.90), dilated cardiomyopathy (HR, 3.33; 95% CI, 2.18–5.10), and valvular heart disease (HR, 3.97; 95% CI, 2.25–6.99) had the worst prognoses. Delayed high‐rate detection was enabled in 39.7% of patients, and single‐zone programming occurred in 52.6% of primary prevention patients. Both parameters correlated with lower risk of first appropriate ICD therapy, with no excess risk of mortality. The rate of inappropriate shocks at follow‐up was low (6%) and did not differ among type of ICD but was lower in SmartShock‐capable devices. Conclusions Irrespective of the cause, contemporary ICD patients with heart failure–related disorders had a similar risk of ICD life‐saving interventions and death. Current ICD programming recommendations still need to be implemented. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NTC01561144.
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Affiliation(s)
- Sem Briongos-Figuero
- Hospital Universitario Infanta Leonor Madrid Spain.,Universidad Complutense de Madrid Madrid Spain
| | | | - Jerónimo Rubio
- Hospital Clínico Universitario de Valladolid Valladolid Spain
| | | | | | | | - Javier Alzueta
- Hospital Universitario Virgen de la Victoria Málaga Spain
| | | | | | | | | | | | | | - Luisa Pérez
- Complexo Hospitalario Universitario de A Coruña A Coruña Spain
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17
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Affiliation(s)
- Sofian Johar
- Department of Cardiology Raja Isteri Pengiran Anak Saleha Hospital and Gleneagles Jerudong Park Medical Centre, Bandar Seri Begawan, Brunei
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18
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Madjarov JM, Madzharov S, Abedinov F, Chappuis S, Fedor JM. Revision of subcutaneous implantable cardioverter defibrillator to intermuscular pocket to prevent inappropriate shocks. Clin Case Rep 2020; 8:1081-1085. [PMID: 32577270 PMCID: PMC7303875 DOI: 10.1002/ccr3.2819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 02/14/2020] [Accepted: 03/07/2020] [Indexed: 11/23/2022] Open
Abstract
Sensing and defibrillation threshold for a S-ICD are impacted by positioning at implant or revision. The intermuscular pocket prevents device migration and provides appropriate, stable sensing vectors.
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Affiliation(s)
- Jeko M. Madjarov
- Department of Cardiovascular SurgerySanger Heart &Vascular InstituteAtrium HealthCharlotteNorth Carolina
| | - Svetozar Madzharov
- Department of Cardiovascular SurgerySanger Heart &Vascular InstituteAtrium HealthCharlotteNorth Carolina
- Faculty of MedicineSofia Bulgaria Medical UniversitySofiaBulgaria
| | | | | | - John M. Fedor
- Department of ElectrophysiologySanger Heart & Vascular InstituteAtrium HealthCharlotteNorth Carolina
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19
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Bazoukis G, Letsas KP, Vlachos K, Tse G, Manolatos D, Sideris A, Efremidis M, Xydonas S. An uncommon cause of inappropriate ICD shock. Clin Case Rep 2020; 8:1109-1111. [PMID: 32577277 PMCID: PMC7303841 DOI: 10.1002/ccr3.2782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 02/04/2020] [Accepted: 02/11/2020] [Indexed: 11/11/2022] Open
Abstract
In cases of electromagnetic interference (EMI), if the source of the inappropriate EMI cannot be identified, then the sensitivity of the device could be decreased, or the cycle length of the VF detection trigger zone changed.
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Affiliation(s)
- George Bazoukis
- Second Department of CardiologyEvangelismos General Hospital of AthensAthensGreece
| | | | - Konstantinos Vlachos
- Second Department of CardiologyEvangelismos General Hospital of AthensAthensGreece
| | - Gary Tse
- Tianjin Key Laboratory of Ionic‐Molecular Function of Cardiovascular DiseaseDepartment of Cardiology, Tianjin Institute of CardiologySecond Hospital of Tianjin Medical UniversityTianjinChina
- Xiamen Cardiovascular HospitalXiamen UniversityXiamenChina
| | - Dimitrios Manolatos
- Second Department of CardiologyEvangelismos General Hospital of AthensAthensGreece
| | - Antonios Sideris
- Second Department of CardiologyEvangelismos General Hospital of AthensAthensGreece
| | - Michael Efremidis
- Second Department of CardiologyEvangelismos General Hospital of AthensAthensGreece
| | - Sotirios Xydonas
- Second Department of CardiologyEvangelismos General Hospital of AthensAthensGreece
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20
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Ishida Y, Payne JE, Field ME, Gold MR. Electromagnetic interference from left ventricular assist devices in patients with subcutaneous implantable cardioverter-defibrillators. J Cardiovasc Electrophysiol 2020; 31:1195-1201. [PMID: 32128931 DOI: 10.1111/jce.14431] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Revised: 02/07/2020] [Accepted: 02/19/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Interactions of left ventricular assist devices (LVADs) with transvenous implantable cardioverter-defibrillator systems (ICDs) have been widely reported. However, less is known regarding the impact of electromagnetic interference (EMI) from LVADs on subcutaneous ICD function. METHODS AND RESULTS A comprehensive literature search was performed on PubMed, Cochrane central registry, and Google Scholar using the search terms "subcutaneous implantable cardioverter-defibrillator and left ventricular assist devices," "electromagnetic interference, LVAD, and subcutaneous ICD," "EMI and S-ICD," and "inappropriate shocks, LVAD, and ICD." Demographic and programming data were extracted from the reports and authors as needed. A total of seven cases of EMI in LVAD patients with subcutaneous ICD (S-ICD) devices were found. In addition three previously unreported cases from our center were included. All cases involved either a heartware ventricular assist device or HeartMate III LVAD with a pre-existing S-ICD. In all patients, both the primary and secondary vectors had inappropriate sensing due to EMI. Three patients were reprogramed to the alternate vector with appropriate sensing. The S-ICD was either inactivated or replaced with a transvenous device in six patients. A single patient was left sensing in the alternate vector. There were no reports of inability to interrogate S-ICD systems in patients with LVADs. CONCLUSION The risk of inappropriate shocks from LVADs should be considered in pre-existing patients with S-ICD, particularly when the heartware ventricular assist device or HeartMate III LVAD device is present. Reprogramming of the sensing vector can occasionally avoid this issue but often the S-ICD needs to be inactivated.
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Affiliation(s)
- Yuji Ishida
- Division of Cardiology, Medical University of South Carolina, Charleston, South Carolina.,Department of Cardiology, Hirosaki University Graduate School of Medicine, Hirosaki, Aomori, Japan
| | - Joshua E Payne
- Division of Cardiology, Medical University of South Carolina, Charleston, South Carolina
| | - Michael E Field
- Division of Cardiology, Medical University of South Carolina, Charleston, South Carolina
| | - Michael R Gold
- Division of Cardiology, Medical University of South Carolina, Charleston, South Carolina
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21
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Wang S, Wu S, Xu L, Xiao F, Whinnett ZI, Vijayaraman P, Su L, Huang W. Feasibility and Efficacy of His Bundle Pacing or Left Bundle Pacing Combined With Atrioventricular Node Ablation in Patients With Persistent Atrial Fibrillation and Implantable Cardioverter-Defibrillator Therapy. J Am Heart Assoc 2019; 8:e014253. [PMID: 31830874 PMCID: PMC6951078 DOI: 10.1161/jaha.119.014253] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Persistent atrial fibrillation may lead to a higher probability of inappropriate shocks in heart failure patients with an implantable cardioverter‐defibrillator (ICD). The aim of this study was to evaluate the impact of His‐Purkinje conduction system pacing combined with atrioventricular node ablation in improving heart function and preventing inappropriate shock therapy in these patients. Methods and Results A total of 86 consecutive patients with persistent atrial fibrillation and heart failure who had indications for ICD implantation were enrolled from January 2010 to March 2018. His‐Purkinje conduction system pacing with ICD and atrioventricular node ablation was attempted in 55 patients, and the remaining patients underwent ICD implantation only. Left ventricular (LV) ejection fraction, LV end‐systolic volume, New York Heart Association (NYHA) classification, shock therapies, and drug therapy were assessed during follow‐up. Overall, 31 patients received ICD implantation with optimal drug therapy (group 1). atrioventricular node ablation combined with His‐Purkinje conduction system pacing was successfully achieved in 52 patients (group 2). During follow‐up, patients in group 2 had lower incidence of inappropriate shock (15.6% versus 0%, P<0.01) and adverse events (P=0.011). Meanwhile, improvement in LV ejection fraction and reduction in LV end‐systolic volume were significantly higher in group 2 than in group 1 (15% versus 3%, P<0.001; and 40 versus 2 mL, P<0.01, respectively). NYHA functional class improved in both groups from a baseline 2.57±0.68 to 1.73±0.74 in group 1 and 2.73±0.59 to 1.42±0.53 in group 2 (P<0.01). Conclusions His‐Purkinje conduction system pacing combined with atrioventricular node ablation is feasible and safe with a high success rate in persistent atrial fibrillation patients with heart failure and ICD indication. It can significantly reduce the incidence of inappropriate shocks and improve LV function.
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Affiliation(s)
- Songjie Wang
- Department of Cardiology the First Affiliated Hospital of Wenzhou Medical University Wenzhou China.,Key Lab of Cardiovascular Disease of Wenzhou Wenzhou China
| | - Shengjie Wu
- Department of Cardiology the First Affiliated Hospital of Wenzhou Medical University Wenzhou China.,Key Lab of Cardiovascular Disease of Wenzhou Wenzhou China
| | - Lei Xu
- Department of Cardiology the First Affiliated Hospital of Wenzhou Medical University Wenzhou China.,Key Lab of Cardiovascular Disease of Wenzhou Wenzhou China
| | - Fangyi Xiao
- Department of Cardiology the First Affiliated Hospital of Wenzhou Medical University Wenzhou China.,Key Lab of Cardiovascular Disease of Wenzhou Wenzhou China
| | - Zachary I Whinnett
- National Heart and Lung Institute Imperial College London United Kingdom
| | | | - Lan Su
- Department of Cardiology the First Affiliated Hospital of Wenzhou Medical University Wenzhou China.,Key Lab of Cardiovascular Disease of Wenzhou Wenzhou China
| | - Weijian Huang
- Department of Cardiology the First Affiliated Hospital of Wenzhou Medical University Wenzhou China.,Key Lab of Cardiovascular Disease of Wenzhou Wenzhou China
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22
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Korantzopoulos P, Manolis G, Manolis AG. ICD triple counting leading to a lethal inappropriate shock. J Cardiovasc Electrophysiol 2019; 31:231-233. [PMID: 31778244 DOI: 10.1111/jce.14292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 11/25/2019] [Accepted: 11/26/2019] [Indexed: 12/01/2022]
Affiliation(s)
| | - George Manolis
- Department of Cardiology, Hellenic Red Cross Hospital, Athens, Greece
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23
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Shah PJ, Kapoor A. Pseudo inappropriate shock: A technical dilemma. Ann Card Anaesth 2019; 22:435-436. [PMID: 31621682 PMCID: PMC6813713 DOI: 10.4103/aca.aca_109_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
With liberal availability of high end cardiac implantable devices in recent era, we frequently encounter patients who are recipients of implantable cardioverter defibrillators (ICDs) in our routine clinical practice. Despite improvements in shock detecting algorithms by various manufacturers, incidence of inappropriate shock therapy remains high, it is cause of distress to physicians and patients. Here we present an interesting case of inappropriate shock in one of patient.
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Affiliation(s)
- Pujan J Shah
- Department of Cardiology, SGPGIMS, Lucknow, Uttar Pradesh, India
| | - Aditya Kapoor
- Department of Cardiology, SGPGIMS, Lucknow, Uttar Pradesh, India
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24
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Di Stolfo G, Mastroianno S, Massaro R, Vigna C, Russo A, Potenza DR. Inappropriate shock and percutaneous cardiac intervention: A lesson to learn in the cath lab. Pacing Clin Electrophysiol 2019; 42:1496-1498. [PMID: 31420987 DOI: 10.1111/pace.13784] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2019] [Revised: 08/02/2019] [Accepted: 08/15/2019] [Indexed: 11/27/2022]
Abstract
Coronary disease is a common condition in patients affected by heart failure with severely reduced ejection fraction (HFrEF). This condition represents an indication for implantable cardioverter defibrillator (ICD) in order to reduce the risk of sudden death related to arrhythmias. Nevertheless, inappropriate shocks are associated with worse quality of life, hospitalization, and death. We present the case of an inappropriate shock related to percutaneous coronary intervention during the insertion and advancement of the guidewire into the left anterior descending artery (LAD) in a patient with an ICD. Physicians' awareness about the clinical implication of noise arising during a coronary procedure is very important in patients with an ICD or pacemaker, to avoid inappropriate shock or pacing inhibition and to raise the possibility of lead implantation in or helix protrusion into the coronary lumen.
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Affiliation(s)
- Giuseppe Di Stolfo
- Cardiovascular Department, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo
| | - Sandra Mastroianno
- Cardiovascular Department, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo
| | - Raimondo Massaro
- Cardiovascular Department, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo
| | - Carlo Vigna
- Cardiovascular Department, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo
| | - Aldo Russo
- Cardiovascular Department, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo
| | - Domenico Rosario Potenza
- Cardiovascular Department, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo
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25
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Nishinarita R, Kishihara J, Matsuura G, Arakawa Y, Kobayashi S, Shirakawa Y, Horiguchi A, Nakamura H, Ishizue N, Oikawa J, Fukaya H, Niwano S, Ako J. Early inappropriate shock in a subcutaneous cardiac defibrillator due to subcutaneous air. J Arrhythm 2019; 35:682-684. [PMID: 31410242 PMCID: PMC6686347 DOI: 10.1002/joa3.12210] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Revised: 05/17/2019] [Accepted: 06/02/2019] [Indexed: 11/08/2022] Open
Abstract
A 57-year-old man was admitted to our hospital due to syncopal attack. He was diagnosed with Brugada syndrome due to which a subcutaneous implantable cardiac defibrillator (S-ICD) was inserted using the standard technique. Two hours after the implantation, he experienced inappropriate shock while conscious. Device interrogation revealed a contentious baseline shift and frequent oversensing of low-amplitude signals, which was followed by a shock. Lateral chest X-ray revealed subcutaneous air surrounding the proximal electrode. Another inappropriate shock could be avoided by changing the sensing vector. The subcutaneous air was completely resolved 7 days after implantation.
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Affiliation(s)
- Ryo Nishinarita
- Department of Cardiovascular MedicineKitasato University School of MedicineSagamiharaJapan
| | - Jun Kishihara
- Department of Cardiovascular MedicineKitasato University School of MedicineSagamiharaJapan
| | - Gen Matsuura
- Department of Cardiovascular MedicineKitasato University School of MedicineSagamiharaJapan
| | - Yuki Arakawa
- Department of Cardiovascular MedicineKitasato University School of MedicineSagamiharaJapan
| | - Shuhei Kobayashi
- Department of Cardiovascular MedicineKitasato University School of MedicineSagamiharaJapan
| | - Yuki Shirakawa
- Department of Cardiovascular MedicineKitasato University School of MedicineSagamiharaJapan
| | - Ai Horiguchi
- Department of Cardiovascular MedicineKitasato University School of MedicineSagamiharaJapan
| | - Hironori Nakamura
- Department of Cardiovascular MedicineKitasato University School of MedicineSagamiharaJapan
| | - Naruya Ishizue
- Department of Cardiovascular MedicineKitasato University School of MedicineSagamiharaJapan
| | - Jun Oikawa
- Department of Cardiovascular MedicineKitasato University School of MedicineSagamiharaJapan
| | - Hidehira Fukaya
- Department of Cardiovascular MedicineKitasato University School of MedicineSagamiharaJapan
| | - Shinichi Niwano
- Department of Cardiovascular MedicineKitasato University School of MedicineSagamiharaJapan
| | - Junya Ako
- Department of Cardiovascular MedicineKitasato University School of MedicineSagamiharaJapan
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26
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Marinheiro R, Parreira L, Amador P, Mesquita D, Almeida L, Lousinha A, Farinha J, Fonseca M, Esteves AF, Caria R. An inappropriate shock after reprogramming tachycardia zones. J Arrhythm 2019; 35:679-681. [PMID: 31410241 PMCID: PMC6686289 DOI: 10.1002/joa3.12212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 06/01/2019] [Accepted: 06/06/2019] [Indexed: 11/09/2022] Open
Abstract
A patient with an implantable cardioverter-defibrillator (ICD) (Abbott®) had episodes of slow monomorphic ventricular tachycardia (VT) and his ICD was programmed with three tachycardia zones. During the follow-up, he received an inappropriate shock. Upon interrogation (of the device), trigeminal pattern binned as ventricular sensing (VS)-VS-ventricular fibrillation (VF) was detected. VF was assumed according to binning system. When VF is present, discrimination algorithms are not available and five consecutive sinus beats are necessary to reset binning system. Catheter ablation was performed to treat VT in order to reprogram tachycardia zones.
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Affiliation(s)
| | | | | | | | | | - Ana Lousinha
- Centro Hospitalar Lisboa Central EPELisboaPortugal
| | | | | | | | - Rui Caria
- Centro Hospitalar de Setubal EPESetubalPortugal
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27
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Ferretto S, Brunzin K, Pettenuzzo K, Nangah Suh R, Canali C, Di Pede F. Inappropriate implantable cardioverter defibrillator shocks due to atrial far-field on the tip-to-ring channel for lead dislodgement. J Arrhythm 2019; 35:562-564. [PMID: 31293710 PMCID: PMC6595376 DOI: 10.1002/joa3.12180] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Accepted: 03/22/2019] [Indexed: 12/05/2022] Open
Abstract
We reported a case of inappropriate implantable cardioverter defibrillator shocks, due to atrial far-field on the tip-to-ring channel of the fast electrical activity during atrial fibrillation, caused by lead dislocation in the right ventricle outflow tract. During these episodes the can-to-right ventricle coil signal correctly recorded the ventricular activity. The shock storm stopped when an antitachycardia pacing restored sinus rhythm.
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Affiliation(s)
- Sonia Ferretto
- Department of CardiologySan Donà di Piave HospitalVeniceItaly
| | - Katia Brunzin
- Department of CardiologySan Donà di Piave HospitalVeniceItaly
| | | | - René Nangah Suh
- Department of CardiologySan Donà di Piave HospitalVeniceItaly
| | - Cristina Canali
- Department of CardiologySan Donà di Piave HospitalVeniceItaly
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28
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Tachibana M, Nishii N, Banba K, Fujita S, Ikeda E, Okawa K, Morita H, Ito H. SMART pass will prevent inappropriate operation of S-ICD. J Arrhythm 2019; 35:86-91. [PMID: 30805048 PMCID: PMC6373830 DOI: 10.1002/joa3.12141] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 10/04/2018] [Accepted: 10/21/2018] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Compared to screening ECG before implantation of a subcutaneous implantable cardioverter-defibrillator (S-ICD), selectable vectors without T-wave oversensing increase after S-ICD implantation. Newer algorithms have recently become available to reduce T-wave oversensing, such as SMART pass (SP). With this function, more selectable vectors are identified after S-ICD implantation. However, this improvement in eligibility utilizing SP has not yet been well validated. We aimed to clarify S-ICD eligibility before and after S-ICD implantation with and without SP. METHODS Participants comprised 34 patients implanted with an S-ICD at Okayama University Hospital and its affiliated hospitals between February 2016 and August 2017. A total of 102 S-ICD vectors were assessed for eligibility before and after S-ICD implantation, at rest and during exercise testing. Vector availability was evaluated in the presence and absence of SP after S-ICD implantation. RESULTS Subcutaneous implantable cardioverter-defibrillator eligibility was significantly better after implantation even without SP than S-ICD screening before S-ICD implantation, both at rest (before 65.7% vs after 95.1%, P < 0.01) and during exercise (before 59.3% vs after 90.6%, P < 0.01). SP improved S-ICD eligibility during exercise (SP on 97.9% vs off 90.6%, P = 0.03). Multivariate analysis showed the prevalence of S-ICD eligibility increased significantly after S-ICD implantation compared to screening before implantation. SP further increased selectable vectors in multivariate analysis. CONCLUSION Available vectors increased significantly after S-ICD implantation compared to preoperative vectors as assessed by S-ICD screening ECG. T-wave oversensing during exercise has been an unresolved issue for S-ICD, but SP will help prevent inappropriate operation with S-ICD.
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Affiliation(s)
- Motomi Tachibana
- Department of CardiologySakakibara Heart Institute of OkayamaOkayamaJapan
| | - Nobuhiro Nishii
- Department of Cardiovascular TherapeuticsOkayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesOkayamaJapan
| | - Kimikazu Banba
- Department of CardiologySakakibara Heart Institute of OkayamaOkayamaJapan
| | - Shinpei Fujita
- Department of CardiologyFukuyama City HospitalFukuyamaJapan
| | - Etsuko Ikeda
- Department of CardiologyTsuyama Central HospitalOkayamaJapan
| | - Keisuke Okawa
- Department of CardiologyKagawa Prefecture Central HospitalKagawaJapan
| | - Hiroshi Morita
- Department of Cardiovascular TherapeuticsOkayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesOkayamaJapan
| | - Hiroshi Ito
- Department of Cardiovascular MedicineOkayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesOkayamaJapan
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29
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Yeo C, Nair GM, Green M. Recurrent shocks in a dual chamber implantable cardioverter defibrillator: Making sense of the chaos. J Arrhythm 2018; 34:661-663. [PMID: 30555615 PMCID: PMC6288556 DOI: 10.1002/joa3.12112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 07/11/2018] [Accepted: 07/31/2018] [Indexed: 11/08/2022] Open
Affiliation(s)
- Colin Yeo
- Department of Cardiology Changi General Hospital Singapore Singapore
| | - Girish M Nair
- Arrhythmia Service Division of Cardiology University of Ottawa Heart Institute Ottawa Canada
| | - Martin Green
- Arrhythmia Service Division of Cardiology University of Ottawa Heart Institute Ottawa Canada
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30
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Turner SL, Singh SM. An "UninTENSional" Subcutaneous Implantable Cardioverter-defibrillator Shock. J Innov Card Rhythm Manag 2018; 9:3395-3397. [PMID: 32477788 PMCID: PMC7252790 DOI: 10.19102/icrm.2018.091106] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 04/05/2018] [Indexed: 02/06/2023] Open
Abstract
Subcutaneous implantable cardioverter-defibrillators (ICDs) (S-ICDs) are advantageous because they eliminate the need for transvenous leads. However, just like in the case of traditional ICDs, inappropriate shocks are an unwanted complication that may result following their placement. In this case, we discuss the mechanism of an inappropriate shock in a patient with an S-ICD.
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Affiliation(s)
- Suzette L Turner
- Department of Cardiology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Sheldon M Singh
- Department of Cardiology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
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31
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Kurt M, Jathanna N, Babady M, Schmidt J, Müller P, Gerguri S, Clasen L, Bejinariu A, Kelm M, Fürnkranz A, Makimoto H. Avoiding inappropriate therapy of single-lead implantable cardioverter-defibrillator by using atrial-sensing electrodes. J Cardiovasc Electrophysiol 2018; 29:1682-1689. [PMID: 30203568 DOI: 10.1111/jce.13736] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2018] [Revised: 08/22/2018] [Accepted: 08/27/2018] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The single-chamber implantable cardioverter-defibrillator (ICD) can be associated with more frequent inappropriate therapies compared with dual-chamber ICDs, when they are accompanied by a simpler implantation procedure. The aim of this study was to investigate whether the use of a single-lead ICD system with atrial-sensing electrodes results in a reduction of inappropriate ICD therapy. METHODS AND RESULTS The study population consisted of 212 consecutive patients, who underwent primary prophylactic single-lead ICD implantation at our institute. A ventricular lead with atrial-sensing electrodes was implanted in 77 patients (36%; Group-VDD) and a ventricular lead without atrial-sensing electrodes was implanted in 135 patients (64%; Group-VVI). Procedural and follow-up data were collected in a prospective registry. A higher prevalence of atrial fibrillation was present in Group-VDD. There were no other significant differences in patient baseline characteristics (age, sex, and other comorbidities) or follow-up period between the two groups. The operative parameters including fluoroscopic burden showed no significant differences between Group-VDD and Group-VVI. During a mean follow-up period of 697 ± 392 days, 26 patients (12%) experienced appropriate ICD therapies and 13 patients (6%) suffered inappropriate ICD therapies. The incidence of inappropriate ICD therapies in Group-VDD was significantly lower as compared to that of Group-VVI (1/77 [1%] vs 12/135 [9%]; log-rank, P = 0.028). The incidence of appropriate ICD therapies and the occurrence of device-related complications showed no significant difference between the two groups. CONCLUSION Single-lead ICD with atrial-sensing electrodes shows a lower incidence of inappropriate ICD therapy compared with the absence of atrial-sensing electrodes, without additional operative burden or increased complications.
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Affiliation(s)
- Muhammed Kurt
- Department of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty of the Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Nikesh Jathanna
- Department of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty of the Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Mehran Babady
- Department of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty of the Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Jan Schmidt
- Department of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty of the Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Patrick Müller
- Department of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty of the Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Shqipe Gerguri
- Department of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty of the Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Lukas Clasen
- Department of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty of the Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Alexandru Bejinariu
- Department of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty of the Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Malte Kelm
- Department of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty of the Heinrich Heine University Düsseldorf, Düsseldorf, Germany.,Cardiovascular Research Institute Duesseldorf (CARID), Medical Faculty of the Heinrich Heine University Düsseldorf, Duesseldorf, Germany
| | - Alexander Fürnkranz
- Department of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty of the Heinrich Heine University Düsseldorf, Düsseldorf, Germany.,Cardiovascular Research Institute Duesseldorf (CARID), Medical Faculty of the Heinrich Heine University Düsseldorf, Duesseldorf, Germany
| | - Hisaki Makimoto
- Department of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty of the Heinrich Heine University Düsseldorf, Düsseldorf, Germany.,Cardiovascular Research Institute Duesseldorf (CARID), Medical Faculty of the Heinrich Heine University Düsseldorf, Duesseldorf, Germany
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32
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Hori Y, Nakahara S, Nishiyama N, Fukuda R, Toratani N, Sakai Y, Taguchi I. Limitation of the bandpass filter in preventing oversensing of pectoral myopotentials over the long-term follow-up. J Arrhythm 2018; 34:580-582. [PMID: 30327706 PMCID: PMC6174498 DOI: 10.1002/joa3.12104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 06/25/2018] [Accepted: 07/09/2018] [Indexed: 11/11/2022] Open
Abstract
A 60-year-old male experienced an inappropriate shock from an implantable cardioverter-defibrillator (ICD) because of oversensing of pectoral myopotentials. Battery depletion was also observed, and a generator change was performed. A single-chamber ICD (VENTAK PRIZM II 1860) was changed to a new ICD (INCEPTA VR F161). The myopotentials were clearly eliminated by the difference in the band pass filter (PRIZM; 21-171 Hz, INCEPTA; 20-85 Hz), but unfortunately, new noise was documented 4 years later. The utility of the bandpass filter for preventing oversensing of myopotentials was observed, but the limitation of its use for long-term follow-up was also indicated.
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Affiliation(s)
- Yuichi Hori
- Department of CardiologyDokkyo Medical University Saitama Medical centerSaitamaJapan
| | - Shiro Nakahara
- Department of CardiologyDokkyo Medical University Saitama Medical centerSaitamaJapan
| | - Naoki Nishiyama
- Department of CardiologyDokkyo Medical University Saitama Medical centerSaitamaJapan
| | - Reiko Fukuda
- Department of CardiologyDokkyo Medical University Saitama Medical centerSaitamaJapan
| | - Noritaka Toratani
- Department of CardiologyDokkyo Medical University Saitama Medical centerSaitamaJapan
| | - Yoshihiko Sakai
- Department of CardiologyDokkyo Medical University Saitama Medical centerSaitamaJapan
| | - Isao Taguchi
- Department of CardiologyDokkyo Medical University Saitama Medical centerSaitamaJapan
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33
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Tondo C. Considering Factors in the Single- Versus Dual-coil Lead Debate. J Innov Card Rhythm Manag 2018; 9:3357-3358. [PMID: 32496481 PMCID: PMC7252893 DOI: 10.19102/icrm.2018.091008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Claudio Tondo
- Heart Rhythm Center at Monzino Cardiac Centre, IRCCS Department of Clinical Sciences and Community Health University of Milan, Milan, Italy
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34
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Ploux S, Swerdlow CD, Strik M, Welte N, Klotz N, Ritter P, Haïssaguerre M, Bordachar P. Towards eradication of inappropriate therapies for ICD lead failure by combining comprehensive remote monitoring and lead noise alerts. J Cardiovasc Electrophysiol 2018; 29:1125-1134. [PMID: 29858871 DOI: 10.1111/jce.13653] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 04/19/2018] [Accepted: 05/01/2018] [Indexed: 01/01/2023]
Abstract
INTRODUCTION Recognition of implantable cardioverter defibrillator (ICD) lead malfunction before occurrence of life threatening complications is crucial. We aimed to assess the effectiveness of remote monitoring associated or not with a lead noise alert for early detection of ICD lead failure. METHODS From October 2013 to April 2017, a median of 1,224 (578-1,958) ICD patients were remotely monitored with comprehensive analysis of all transmitted materials. ICD lead failure and subsequent device interventions were prospectively collected in patients with (RMLN) and without (RM) a lead noise alert (Abbott Secure Sense™ or Medtronic Lead Integrity Alert™) in their remote monitoring system. RESULTS During a follow-up of 4,457 patient years, 64 lead failures were diagnosed. Sixty-one (95%) of the diagnoses were made before any clinical complication occurred. Inappropriate shocks were delivered in only one patient of each group (3%), with an annual rate of 0.04%. All high voltage conductor failures were identified remotely by a dedicated impedance alert in 10 patients. Pace-sense component failures were correctly identified by a dedicated alert in 77% (17 of 22) of the RMLN group versus 25% (8 of 32) of the RM group (P = 0.002). The absence of a lead noise alert was associated with a 16-fold increase in the likelihood of initiating either a shock or ATP (OR: 16.0, 95% CI 1.8-143.3; P = 0.01). CONCLUSION ICD remote monitoring with systematic review of all transmitted data is associated with a very low rate of inappropriate shocks related to lead failure. Dedicated noise alerts further reduce inappropriate detection of ventricular arrhythmias.
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Affiliation(s)
- Sylvain Ploux
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, F-33600, Pessac- Bordeaux, France.,Bordeaux University Hospital (CHU), Cardio-Thoracic Unit, F-33600, Pessac, France
| | - Charles D Swerdlow
- Cedars-Sinai Heart Center, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - Marc Strik
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, F-33600, Pessac- Bordeaux, France.,Physiology and Cardiology Department, Maastricht University Medical Center, Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands
| | - Nicolas Welte
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, F-33600, Pessac- Bordeaux, France
| | - Nicolas Klotz
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, F-33600, Pessac- Bordeaux, France
| | - Philippe Ritter
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, F-33600, Pessac- Bordeaux, France.,Bordeaux University Hospital (CHU), Cardio-Thoracic Unit, F-33600, Pessac, France
| | - Michel Haïssaguerre
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, F-33600, Pessac- Bordeaux, France.,Bordeaux University Hospital (CHU), Cardio-Thoracic Unit, F-33600, Pessac, France
| | - Pierre Bordachar
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, F-33600, Pessac- Bordeaux, France.,Bordeaux University Hospital (CHU), Cardio-Thoracic Unit, F-33600, Pessac, France
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35
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Chang SC, Patton KK, Robinson MR, Poole JE, Prutkin JM. Subcutaneous ICD screening with the Boston Scientific ZOOM programmer versus a 12-lead ECG machine. Pacing Clin Electrophysiol 2018; 41:511-516. [PMID: 29476654 DOI: 10.1111/pace.13314] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Revised: 01/24/2018] [Accepted: 02/17/2018] [Indexed: 01/23/2023]
Abstract
BACKGROUND The subcutaneous implantable cardioverter-defibrillator (S-ICD) requires preimplant screening to ensure appropriate sensing and reduce risk of inappropriate shocks. Screening can be performed using either an ICD programmer or a 12-lead electrocardiogram (ECG) machine. It is unclear whether differences in signal filtering and digital sampling change the screening success rate. METHODS Subjects were recruited if they had a transvenous single-lead ICD without pacing requirements or were candidates for a new ICD. Screening was performed using both a Boston Scientific ZOOM programmer (Marlborough, MA, USA) and General Electric MAC 5000 ECG machine (Fairfield, CT, USA). A pass was defined as having at least one lead that fit within the screening template in both supine and sitting positions. RESULTS A total of 69 subjects were included and 27 sets of ECG leads had differing screening results between the two machines (7%). Of these sets, 22 (81%) passed using the ECG machine but failed using the programmer and five (19%) passed using the ECG machine but failed using the programmer (P < 0.001). Four subjects (6%) passed screening using the ECG machine but failed using the programmer. No subject passed screening with the programmer but failed with the ECG machine. CONCLUSION There can be occasional disagreement in S-ICD patient screening between an ICD programmer and ECG machine, all of whom passed with the ECG machine but failed using the programmer. On a per lead basis, the ECG machine passes more subjects. It is unknown what the inappropriate shock rate would be if an S-ICD was implanted. Clinical judgment should be used in borderline cases.
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Affiliation(s)
- Shu C Chang
- Division of Cardiology, University of Colorado, Aurora, Colorado, USA
| | - Kristen K Patton
- Division of Cardiology, University of Washington, Seattle, Washington, USA
| | - Melissa R Robinson
- Division of Cardiology, University of Washington, Seattle, Washington, USA
| | - Jeanne E Poole
- Division of Cardiology, University of Washington, Seattle, Washington, USA
| | - Jordan M Prutkin
- Division of Cardiology, University of Washington, Seattle, Washington, USA
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36
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Greenlee RT, Go AS, Peterson PN, Cassidy-Bushrow AE, Gaber C, Garcia-Montilla R, Glenn KA, Gupta N, Gurwitz JH, Hammill SC, Hayes JJ, Kadish A, Magid DJ, McManus DD, Multerer D, Powers JD, Reifler LM, Reynolds K, Schuger C, Sharma PP, Smith DH, Suits M, Sung SH, Varosy PD, Vidaillet HJ, Masoudi FA. Device Therapies Among Patients Receiving Primary Prevention Implantable Cardioverter-Defibrillators in the Cardiovascular Research Network. J Am Heart Assoc 2018; 7:e008292. [PMID: 29581222 PMCID: PMC5907599 DOI: 10.1161/jaha.117.008292] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Accepted: 02/15/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Primary prevention implantable cardioverter-defibrillators (ICDs) reduce mortality in selected patients with left ventricular systolic dysfunction by delivering therapies (antitachycardia pacing or shocks) to terminate potentially lethal arrhythmias; inappropriate therapies also occur. We assessed device therapies among adults receiving primary prevention ICDs in 7 healthcare systems. METHODS AND RESULTS We linked medical record data, adjudicated device therapies, and the National Cardiovascular Data Registry ICD Registry. Survival analysis evaluated therapy probability and predictors after ICD implant from 2006 to 2009, with attention to Centers for Medicare and Medicaid Services Coverage With Evidence Development subgroups: left ventricular ejection fraction, 31% to 35%; nonischemic cardiomyopathy <9 months' duration; and New York Heart Association class IV heart failure with cardiac resynchronization therapy defibrillator. Among 2540 patients, 35% were <65 years old, 26% were women, and 59% were white. During 27 (median) months, 738 (29%) received ≥1 therapy. Three-year therapy risk was 36% (appropriate, 24%; inappropriate, 12%). Appropriate therapy was more common in men (adjusted hazard ratio [HR], 1.84; 95% confidence interval [CI], 1.43-2.35). Inappropriate therapy was more common in patients with atrial fibrillation (adjusted HR, 2.20; 95% CI, 1.68-2.87), but less common among patients ≥65 years old versus younger (adjusted HR, 0.72; 95% CI, 0.54-0.95) and in recent implants (eg, in 2009 versus 2006; adjusted HR, 0.66; 95% CI, 0.46-0.95). In Centers for Medicare and Medicaid Services Coverage With Evidence Development analysis, inappropriate therapy was less common with cardiac resynchronization therapy defibrillator versus single chamber (adjusted HR, 0.55; 95% CI, 0.36-0.84); therapy risk did not otherwise differ for Centers for Medicare and Medicaid Services Coverage With Evidence Development subgroups. CONCLUSIONS In this community cohort of primary prevention patients receiving ICD, therapy delivery varied across demographic and clinical characteristics, but did not differ meaningfully for Centers for Medicare and Medicaid Services Coverage With Evidence Development subgroups.
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MESH Headings
- Aged
- Arrhythmias, Cardiac/diagnosis
- Arrhythmias, Cardiac/mortality
- Arrhythmias, Cardiac/physiopathology
- Arrhythmias, Cardiac/prevention & control
- Centers for Medicare and Medicaid Services, U.S.
- Death, Sudden, Cardiac/prevention & control
- Defibrillators, Implantable
- Electric Countershock/adverse effects
- Electric Countershock/instrumentation
- Electric Countershock/mortality
- Female
- Heart Rate
- Humans
- Male
- Middle Aged
- Primary Prevention/instrumentation
- Retrospective Studies
- Risk Factors
- Time Factors
- Treatment Outcome
- United States
- Ventricular Dysfunction, Left/diagnosis
- Ventricular Dysfunction, Left/mortality
- Ventricular Dysfunction, Left/physiopathology
- Ventricular Dysfunction, Left/therapy
- Ventricular Function, Left
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Affiliation(s)
| | - Alan S Go
- Kaiser Permanente Northern California, Oakland, CA
| | - Pamela N Peterson
- Denver Health Medical Center, Denver, CO
- University of Colorado Anschutz Medical Campus, Aurora, CO
| | | | | | | | | | - Nigel Gupta
- Kaiser Los Angeles Medical Center, Los Angeles, CA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Sue Hee Sung
- Kaiser Permanente Northern California, Oakland, CA
| | - Paul D Varosy
- Department of Veterans Affairs Eastern Colorado Health System, Denver, CO
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37
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Goldstein SA, LaPage MJ, Dechert BE, Serwer GA, Yu S, Lowery RE, Bradley DJ. Decreased inappropriate shocks with new generation ICDs in children and patients with congenital heart disease. CONGENIT HEART DIS 2018; 13:413-418. [PMID: 29372620 DOI: 10.1111/chd.12585] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Revised: 11/17/2017] [Accepted: 12/22/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Inappropriate implantable cardioverter defibrillator (ICD) shocks in children and patients with congenital heart disease (CHD) remain a major complication of device therapy, occurring in as many as 50% of children with ICDs. New generation devices include algorithms designed to minimize inappropriate shocks. This study aimed to evaluate the effect of new generation ICDs on the incidence of inappropriate shocks in the pediatric and CHD population. DESIGN Retrospective study of patients with CHD or under age 25 receiving ICDs between 2000 and 2015. New generation ICDs were defined as those with Medtronic "SmartShock" algorithms. RESULTS Two hundred eight devices were implanted in 146 patients. Rates of inappropriate shocks were similar between diagnoses (P = .71). The rate of inappropriate shock was 15% over median 5.8 years follow-up. In the 36 patients (25%) with new generation ICDs, the rate of inappropriate shock was 6.3% over 4 years. Comparing old to new generation ICDs, freedom from first inappropriate shock was 90.6% versus 97.1% at 1 year and 80.4% versus 97.1% at 3 years (P = .01). Lead fracture was associated with having inappropriate shock (hazard ratio 8.5, P < .0001), and there was no significant difference between the device groups when lead fractures were excluded. Clinical actions were taken in 69% of patients after initial inappropriate shock (such as medication or program change, system revision, or explant). When an action was taken, subsequent inappropriate shock was reduced (5.3% vs 49.2% at 1 year; P = .002). CONCLUSIONS Pediatric and CHD patients are experiencing reduced inappropriate shocks with new generation ICD systems, though reduced lead fracture may account for this improvement. Clinical interventions after inappropriate shock favorably impact the subsequent rate of shocks once an inappropriate shock occurs.
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Affiliation(s)
| | - Martin J LaPage
- University of Michigan Congenital Heart Center, Ann Arbor, Michigan, USA
| | - Brynn E Dechert
- University of Michigan Congenital Heart Center, Ann Arbor, Michigan, USA
| | - Gerald A Serwer
- University of Michigan Congenital Heart Center, Ann Arbor, Michigan, USA
| | - Sunkyung Yu
- University of Michigan Congenital Heart Center, Ann Arbor, Michigan, USA
| | - Ray E Lowery
- University of Michigan Congenital Heart Center, Ann Arbor, Michigan, USA
| | - David J Bradley
- University of Michigan Congenital Heart Center, Ann Arbor, Michigan, USA
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38
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Abstract
Although implantable cardioverter-defibrillators (ICDs) have proven to be life-saving devices, there are frequent complications associated with their use, especially in the pediatric and congenital heart disease populations. Inappropriate shocks are a particularly frequent complication in these groups. This review discusses the causes and implications of inappropriate ICD shocks, and presents potential interventions that may assist in safely reducing the rates of inappropriate shocks in pediatric and congenital heart disease patients with ICDs.
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Affiliation(s)
- Jason M Garnreiter
- Department of Pediatrics, Saint Louis University School of Medicine, St. Louis, MO, USA
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39
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Lee S, Souvaliotis N, Mehta D, Suri R. Inappropriate shock in a subcutaneous cardiac defibrillator due to residual air. Clin Case Rep 2017; 5:1203-1206. [PMID: 28781823 PMCID: PMC5538068 DOI: 10.1002/ccr3.1009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Revised: 03/08/2017] [Accepted: 04/15/2017] [Indexed: 12/02/2022] Open
Abstract
Inappropriate shock due to residual air in subcutaneous implantable cardiac defibrillators is not a well‐known complication. Obtaining overpenetrated X‐rays, recognizing electrocardiogram findings, limiting blunt finger dissection, and switching to sense at another vector are techniques which might lead to avoidance of unnecessary wound exploration or device removal.
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Affiliation(s)
- Shawn Lee
- Mount Sinai St. Luke's Hospital New York City New York
| | | | | | - Ranjit Suri
- Mount Sinai St. Luke's Hospital New York City New York
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40
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Pérez-Rodon J, Doiny D, Miranda B, Rivas-Gandara N, Roca-Luque I, Francisco-Pascual J, Lidón RM, García-Dorado D, Moya Mitjans A. Life-threatening and life-saving inappropriate implantable cardioverter defibrillator shocks. Clin Case Rep 2017; 5:521-525. [PMID: 28396781 PMCID: PMC5378847 DOI: 10.1002/ccr3.893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2016] [Revised: 01/18/2017] [Accepted: 02/13/2017] [Indexed: 11/22/2022] Open
Abstract
An implantable cardioverter defibrillator (ICD) lead dislodgement into the right atrium is a dangerous situation, particularly in patients in atrial fibrillation because atrial fibrillation can be sensed as ventricular fibrillation and true ventricular fibrillation induced with an inappropriate shock. In the presence of shocks, ICD interrogation should be performed as soon as possible.
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Affiliation(s)
- Jordi Pérez-Rodon
- Department of Cardiology Arrhythmia Unit Hospital Universitari Vall d'Hebrón Universitat Autònoma de Barcelona Edifici Annexos, planta 9, Passeig Vall d'Hebrón, 119-129 08035 Barcelona Spain
| | - David Doiny
- Department of Cardiology Arrhythmia Unit Hospital Universitari Vall d'Hebrón Universitat Autònoma de Barcelona Edifici Annexos, planta 9, Passeig Vall d'Hebrón, 119-129 08035 Barcelona Spain
| | - Berta Miranda
- Department of Cardiology Hospital Universitari Vall d'Hebrón Universitat Autònoma de Barcelona Edifici Annexos, planta 9, Passeig Vall d'Hebrón, 119-129 08035 Barcelona Spain
| | - Nuria Rivas-Gandara
- Department of Cardiology Arrhythmia Unit Hospital Universitari Vall d'Hebrón Universitat Autònoma de Barcelona Edifici Annexos, planta 9, Passeig Vall d'Hebrón, 119-129 08035 Barcelona Spain
| | - Ivo Roca-Luque
- Department of Cardiology Arrhythmia Unit Hospital Universitari Vall d'Hebrón Universitat Autònoma de Barcelona Edifici Annexos, planta 9, Passeig Vall d'Hebrón, 119-129 08035 Barcelona Spain
| | - Jaume Francisco-Pascual
- Department of Cardiology Arrhythmia Unit Hospital Universitari Vall d'Hebrón Universitat Autònoma de Barcelona Edifici Annexos, planta 9, Passeig Vall d'Hebrón, 119-129 08035 Barcelona Spain
| | - Rosa Maria Lidón
- Department of Cardiology Hospital Universitari Vall d'Hebrón Universitat Autònoma de Barcelona Edifici Annexos, planta 9, Passeig Vall d'Hebrón, 119-129 08035 Barcelona Spain
| | - David García-Dorado
- Department of Cardiology Hospital Universitari Vall d'Hebrón Universitat Autònoma de Barcelona Edifici Annexos, planta 9, Passeig Vall d'Hebrón, 119-129 08035 Barcelona Spain
| | - Angel Moya Mitjans
- Department of Cardiology Arrhythmia Unit Hospital Universitari Vall d'Hebrón Universitat Autònoma de Barcelona Edifici Annexos, planta 9, Passeig Vall d'Hebrón, 119-129 08035 Barcelona Spain
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41
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Pavlů L, Hutyra M, Táborský M. Changing Views: Safety and Efficacy of Implantable Cardioverter- Defibrillator Therapy in Athletes. Cent Eur J Public Health 2016; 23 Suppl:S74-7. [PMID: 26849548 DOI: 10.21101/cejph.a4228] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Accepted: 06/24/2015] [Indexed: 11/15/2022]
Abstract
The implantable cardioverter-defibrillator (ICD) is highly effective in reducing sudden death from ventricular tachyarrhythmia among high-risk cardiac patients. Conventional advice given to patients with ICD is to avoid physical activity more strenuous than playing golf or bowling. This recommendation is given due to a theoretical risk of arrhythmia precipitation, and thus increased risk of death due to failure to defibrillate, injury resulting from loss of control caused by arrhythmia-related syncope or shock, and also due to sport related direct damage to the ICD system. Recent prospective data from an international registry involving 372 athletes with ICDs in situ and actively participating in sports has been published. This indicates that, although physical activity resulted in an increased number of shocks compared to rest, there was no significant difference between intensive physical activity and any other activity (10% vs. 8%, p=0.34) in frequency of shocks. Furthermore, over a median follow-up period of 31 months (21-46 months), in the period of sports activity and 2 hour rest directly after there were no occurrences of death, resuscitated arrest or arrhythmia, or shock-related injury. This data is likely to start a shift in every-day clinical decision-making leading to revision of the high level of precautions imposed on the rapidly enlarging ICD recipient population.
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Affiliation(s)
- Luděk Pavlů
- 1st Department of Internal Medicine - Cardiology, University Hospital, Olomouc, Czech Republic
| | - Martin Hutyra
- 1st Department of Internal Medicine - Cardiology, University Hospital, Olomouc, Czech Republic
| | - Miloš Táborský
- 1st Department of Internal Medicine - Cardiology, University Hospital, Olomouc, Czech Republic
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42
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Abstract
Although conventional implantable cardioverter-defibrillators (ICDs) have proved effective in the prevention of sudden cardiac death (SCD), they still appear to be limited by non-trivial acute and long-term complications. The recent advent of an entirely subcutaneous ICD (S-ICD) represents a further step in the evolution of defibrillation technology towards a less-invasive approach. This review highlights some historical and current issues concerning the S-ICD that may offer a viable therapeutic option in selected patients at high risk of SCD and in whom pacing is not required. After the CE Mark and US Food and Drug Administration (FDA) approvals, the S-ICD is being implanted worldwide with growing clinical data regarding its safety and efficacy (the EFFORTLESS Registry). The recently developed new generation of S-ICD (EMBLEM, Boston Scientific) demonstrates favourable features including a smaller device, longer longevity and remote-monitoring compatibility. Further innovations in the S-ICD system and potential integration with leadless pacing may play an important role in defibrillation therapy and prevention of SCD in the near future.
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Affiliation(s)
- Hussam Ali
- Arrhythmia & Electrophysiology Research Center, IRCCS Humanitas Research Hospital, Rozzano (Milan), Italy; Arrhythmia & Electrophysiology Unit II, Humanitas Gavazzeni Clinics, Bergamo, Italy
| | - Pierpaolo Lupo
- Arrhythmia & Electrophysiology Research Center, IRCCS Humanitas Research Hospital, Rozzano (Milan), Italy; Arrhythmia & Electrophysiology Unit II, Humanitas Gavazzeni Clinics, Bergamo, Italy
| | - Riccardo Cappato
- Arrhythmia & Electrophysiology Research Center, IRCCS Humanitas Research Hospital, Rozzano (Milan), Italy; Arrhythmia & Electrophysiology Unit II, Humanitas Gavazzeni Clinics, Bergamo, Italy
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43
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Thachil A, Chennapragada S, Calambur N. Inappropriate Detection of a Supraventricular Tachycardia as Dual Tachycardia by the PR Logic™ Algorithm. Indian Pacing Electrophysiol J 2014; 14:161-4. [PMID: 24920872 PMCID: PMC4032784 DOI: 10.1016/s0972-6292(16)30758-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Tachycardia detection and therapy algorithms in Implantable Cardioverter-Defibrillators (ICD) reduce, but do not eliminate inappropriate ICD shocks. Awareness of the pros and cons of a particular algorithm helps to predict its utility in specific situations. We report a case where PR logic™, an algorithm commonly used in currently implanted ICDs to differentiate supraventricular tachycardia (SVT) from ventricular tachycardia resulted in inappropriate detection and shock for an SVT, and discuss several solutions to the problem.
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44
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Guédon-Moreau L, Kouakam C, Klug D, Marquié C, Brigadeau F, Boulé S, Blangy H, Lacroix D, Clémenty J, Sadoul N, Kacet S. Decreased delivery of inappropriate shocks achieved by remote monitoring of ICD: a substudy of the ECOST trial. J Cardiovasc Electrophysiol 2014; 25:763-70. [PMID: 24602062 DOI: 10.1111/jce.12405] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Revised: 02/11/2014] [Accepted: 02/14/2014] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Inappropriate shocks remain a highly challenging complication of implantable cardioverter defibrillators (ICD). We examined whether automatic wireless remote monitoring (RM) of ICD, by providing early notifications of triggering events, lowers the incidence of inappropriate shocks. METHODS AND RESULTS We studied 433 patients randomly assigned to RM (n = 221; active group) versus ambulatory follow-up (n = 212; control group). Patients in the active group were seen in the ambulatory department once a year, unless RM reported an event requiring an earlier ambulatory visit. Patients in the control group were seen in the ambulatory department every 6 months. The occurrence of first and further inappropriate shocks, and their causes in each group were compared. The characteristics of the study groups, including pharmaceutical regimens, were similar. Over a follow-up of 27 months, 5.0% of patients in the active group received ≥1 inappropriate shocks versus 10.4% in the control group (P = 0.03). A total of 28 inappropriate shocks were delivered in the active versus 283 in the control group. Shocks were triggered by supraventricular tachyarrhythmias (SVTA) in 48.5%, noise oversensing in 21.2%, T wave oversensing in 15.2%, and lead dysfunction in 15.2% of patients. The numbers of inappropriate shocks delivered per patient, triggered by SVTA and by lead dysfunction, were 74% and 98% lower, respectively, in the active than in the control group. CONCLUSION RM was highly effective in the long-term prevention of inappropriate ICD shocks.
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45
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Kossaify A. Implantable cardioverter defibrillator and inappropriate therapy: "black box" examination yielded both human and technical causes. Clin Med Insights Case Rep 2013; 6:183-7. [PMID: 24348078 PMCID: PMC3859824 DOI: 10.4137/ccrep.s13380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2013] [Revised: 10/28/2013] [Accepted: 11/05/2013] [Indexed: 11/18/2022]
Abstract
We report on a 70-year-old male patient who was recipient of GEM III DR 7275 Cardioverter Defibrillator, and who presented with inappropriate shocks. The patient had a documented slow ventricular tachycardia (VT), and the device was programmed to detect VT at rates >100 bpm, fast VT (FVT, via VT) at rates >150 bpm, and ventricular fibrillation (VF) at rates >188 bpm. After detection of FVT, efficient therapy was delivered; however, this was immediately followed by multiple inappropriate therapies. Inappropriate therapies were discussed, with a focus on programming features.
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Affiliation(s)
- Antoine Kossaify
- Electrophysiology Unit, Cardiology division, USEK- NDS University Hospital, St Charbel Street, Byblos, Lebanon
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46
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DeMazumder D, Lake DE, Cheng A, Moss TJ, Guallar E, Weiss RG, Jones SR, Tomaselli GF, Moorman JR. Dynamic analysis of cardiac rhythms for discriminating atrial fibrillation from lethal ventricular arrhythmias. Circ Arrhythm Electrophysiol 2013; 6:555-61. [PMID: 23685539 DOI: 10.1161/circep.113.000034] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Implantable cardioverter-defibrillators (ICDs), the first line of therapy for preventing sudden cardiac death in high-risk patients, deliver appropriate shocks for termination of ventricular tachycardia (VT)/ventricular fibrillation. A common shortcoming of ICDs is imperfect rhythm discrimination, resulting in the delivery of inappropriate shocks for atrial fibrillation (AF). An underexplored area for rhythm discrimination is the difference in dynamic properties between AF and VT/ventricular fibrillation. We hypothesized that the higher entropy of rapid cardiac rhythms preceding ICD shocks distinguishes AF from VT/ventricular fibrillation. METHODS AND RESULTS In a multicenter, prospective, observational study of patients with primary prevention ICDs, 119 patients received shocks from ICDs with stored, retrievable intracardiac electrograms. Blinded adjudication revealed shocks were delivered for VT/ventricular fibrillation (62%), AF (23%), and supraventricular tachycardia (15%). Entropy estimation of only 9 ventricular intervals before ICD shocks accurately distinguished AF (receiver operating characteristic curve area, 0.98; 95% confidence intervals, 0.93-1.0) and outperformed contemporary ICD rhythm discrimination algorithms. CONCLUSIONS This new strategy for AF discrimination based on entropy estimation expands on simpler concepts of variability, performs well at fast heart rates, and has potential for broad clinical application.
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Affiliation(s)
- Deeptankar DeMazumder
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA.
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Beukema RJ, Misier ARR, Delnoy PPHM, Smit JJJ, Elvan A. Characteristics of Sprint Fidelis lead failure. Neth Heart J 2010; 18:12-17. [PMID: 20111638 PMCID: PMC2810030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023] Open
Abstract
Background. The Medtronic Sprint Fidelis ICD lead is prone to failure and the rate of failure seems to be increasing. The aim of this study was to investigate the rate of Sprint Fidelis lead failure, the characteristics, the mode of presentation and possible predictors of lead failure.Methods and Results. The rate, characteristics and presentation of Sprint Fidelis lead failure was assessed in this single-centre survey. 619 Sprint Fidelis ICD leads were implanted at our centre between December 2004 and August 2007. The mean follow-up was 32+/-10 (range 22-60) months; 35 patients (5.7%) required a lead re-implantation because of failure of the pace-sense conductor. Mean duration of lead survival was 23+/-12 (2-46) months and the rate of failure did not stabilise during follow-up. The mode of presentation was inappropriate shocks in 16 patients (45.7%), alarm alert in 12 patients (34.3%), and detection at routine follow-up in seven patients (20%). In 31 patients (89%), interrogation data revealed a sudden rise in impedance and/or frequent short VV intervals prior to lead failure and in five patients an isolated decrease of R wave (<2.5 mV). The interrogation data were not different from patients with shocks compared with patients without shocks. The interrogation data at routine follow-up in the first three months after implant were normal and stable.Conclusion. The rate of Sprint Fidelis lead failure reaches 5.7% at a mean follow-up duration of 32 months. The rate of failure does not seem to stabilise. Routine follow-up can not predict lead failure or prevent inappropriate shocks. (Neth Heart J 2010;18:12-7.).
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Affiliation(s)
- R J Beukema
- Department of Cardiology, Isala Clinics, Zwolle, the Netherlands
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48
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Santini M, Ricci R. Selecting dual chamber or single chamber implantable defibrillators: what is the golden rule? Indian Pacing Electrophysiol J 2003; 3:261-7. [PMID: 16943926 PMCID: PMC1502057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Affiliation(s)
- Massimo Santini
- Department of Cardiology, San Filippo Neri Hospital, Rome, Italy.
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