Oversensing issues leading to device extraction: When subcutaneous implantable cardioverter-defibrillator reached a dead-end.

Noel, Antoine; Ploux, Sylvain; Bulliard, Samuel; Strik, Marc; Häberlin, Andreas; Welte, Nicolas; Marchand, Hugo; Klotz, Nicolas; Ritter, Philippe; Haïssaguerre, Michel; Bordachar, Pierre (2019). Oversensing issues leading to device extraction: When subcutaneous implantable cardioverter-defibrillator reached a dead-end. (In Press). Heart rhythm Elsevier 10.1016/j.hrthm.2019.07.004

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BACKGROUND Subcutaneous implantable cardioverter-defibrillator (S-ICD) implantations are rapidly expanding. However, the subcutaneous detection and interpretation of cardiac signals in S-ICDs is much more challenging than by conventional devices. There is a complete paradigm shift in cardiac signal sensing with subcutaneous signal detection, leading in some cases to oversensing with restricted programming options. OBJECTIVES The aim of this single-center study was to quantify and describe cases where recurring oversensing made the extraction of the device necessary. METHODS Consecutive patients (n = 108) implanted with an S-ICD in our tertiary referral hospital were considered for analysis. Clinical and remote monitoring data were analyzed. RESULTS The S-ICD had to be explanted in 6 of 108 implanted patients (5.6%) because of refractory oversensing issues: myopotential oversensing, P- or T-wave oversensing, rate-dependent left bundle branch block aberrancy during exercise with R-wave double counting, and R-wave amplitude decrease after ventricular tachycardia ablation leading to noise detection. Seventeen of 108 patients experienced oversensing (15.7%): 9 patients had at least 1 inappropriate charge without a shock (8.3%), 3 patients had at least 1 inappropriate shock (2.8%), and 5 patients had both episodes (4.6%). CONCLUSION So far, cardiologists have had to deal with transvenous ICD lead fractures, but signal oversensing without correcting programming option could be the equivalent weakness of S-ICDs, despite an adequate screening.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Faculty Institutions > sitem Center for Translational Medicine and Biomedical Entrepreneurship > Cardiac Technology and Implantable Devices
04 Faculty of Medicine > Faculty Institutions > sitem Center for Translational Medicine and Biomedical Entrepreneurship
04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiology

UniBE Contributor:

Häberlin, Andreas

Subjects:

600 Technology > 610 Medicine & health
500 Science > 570 Life sciences; biology

ISSN:

1547-5271

Publisher:

Elsevier

Language:

English

Submitter:

Andreas David Heinrich Häberlin

Date Deposited:

08 Oct 2019 10:06

Last Modified:

23 Oct 2019 12:25

Publisher DOI:

10.1016/j.hrthm.2019.07.004

PubMed ID:

31295585

Uncontrolled Keywords:

Implantable cardioverter-defibrillator Inappropriate therapy Oversensing Subcutaneous implantable cardioverter-defibrillator Sudden cardiac death

URI:

https://boris.unibe.ch/id/eprint/133740

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