Sense-B-noise: an enigmatic cause for inappropriate shocks in subcutaneous implantable cardioverter defibrillators.

Haeberlin, Andreas; Burri, Haran; Schaer, Beat; Koepfli, Pascal; Grebmer, Christian; Breitenstein, Alexander; Reichlin, Tobias; Noti, Fabian (2023). Sense-B-noise: an enigmatic cause for inappropriate shocks in subcutaneous implantable cardioverter defibrillators. Europace, 25(2), pp. 767-774. Oxford University Press 10.1093/europace/euac202

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AIMS

Subcutaneous implantable cardioverter defibrillators (S-ICDs) are well established. However, inappropriate shocks (IAS) remain a source of concern since S-ICDs offer very limited troubleshooting options. In our multicentre case series, we describe several patients who experienced IAS due to a previously unknown S-ICD system issue.

METHODS AND RESULTS

We observed six patients suffering from this novel IAS entity. The IAS occurred exclusively in primary or alternate S-ICD sensing vector configuration (therefore called 'Sense-B-noise'). IAS were caused by non-physiologic oversensing episodes characterized by intermittent signal saturation, diminished QRS amplitudes, and disappearance of the artefacts after the IAS. Noise/oversensing could not be provoked by manipulation, X-ray did not show evidence for lead/header issues and impedance measurements were within normal limits. The pooled experience of our centres implies that up to ∼5% of S-ICDs may be affected. The underlying root cause was discussed extensively with the manufacturer but remains unknown and is under further investigation.

CONCLUSION

Sense-B-noise is a novel cause for IAS due to non-physiologic signal oversensing, arising from a previously unknown S-ICD system issue. Sense-B-noise may be suspected if episodes of signal saturation in primary or alternate vector configuration are present, oversensing cannot be provoked, and X-ray and electrical measurements appear normal. The issue can be resolved by reprogramming the device to secondary sensing vector.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiology
10 Strategic Research Centers > ARTORG Center for Biomedical Engineering Research > ARTORG Center - Musculoskeletal Biomechanics

UniBE Contributor:

Häberlin, Andreas David Heinrich, Reichlin, Tobias Roman, Noti, Fabian

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1099-5129

Publisher:

Oxford University Press

Language:

English

Submitter:

Pubmed Import

Date Deposited:

16 Nov 2022 07:31

Last Modified:

18 Feb 2023 00:13

Publisher DOI:

10.1093/europace/euac202

PubMed ID:

36353759

Uncontrolled Keywords:

Device failure Inappropriate shock Oversensing S-ICD Subcutaneous defibrillator

BORIS DOI:

10.48350/174727

URI:

https://boris.unibe.ch/id/eprint/174727

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