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

Noel, Antoine; Ploux, Sylvain; Bulliard, Samuel; Strik, Marc; Haeberlin, Andreas; Welte, Nicolas; Marchand, Hugo; Klotz, Nicolas; Ritter, Philippe; Haïssaguerre, Michel; Bordachar, Pierre (2020). Oversensing issues leading to device extraction: When subcutaneous implantable cardioverter-defibrillator reached a dead-end. Heart rhythm, 17(1), pp. 66-74. 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 > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiology 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
UniBE Contributor:	Häberlin, Andreas David Heinrich
Subjects:	600 Technology > 610 Medicine & health 500 Science > 570 Life sciences; biology
ISSN:	1547-5271
Publisher:	Elsevier
Language:	English
Submitter:	Andreas Häberlin
Date Deposited:	08 Oct 2019 10:06
Last Modified:	05 Dec 2022 15:31
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