Recurrent implantable cardioverter-defibrillator shocks due to automatic deactivation of a right ventricular lead noise discrimination algorithm

• DOI: 10.1016/j.hrcr.2022.07.013
• Publication Date: 2022-08-01T15:57:23Z
• Authors: Thomas Seiler; Claudia Schaarsch...; Mabelle Young; Richard Kobza; Christian Grebmer
• Keywords: 03 medical and health sciences; 0302 clinical medicine; Case Report; ddc:

Key Teaching Points•The Abbott SecureSense (Abbott Medical, St. Paul, Minnesota) algorithm adequately detects right ventricular noise signals by comparing near-field and far-field reduces inappropriate implantable cardioverter-defibrillator (ICD) shocks evoked oversensing.•By default, appliance of the telemetry wand automatically induces passive mode algorithm. As a consequence, are still appropriately detected during device interrogation, but ICD therapy is not withheld, which may allow in case simultaneous or ongoing noise.•To avoid shocks, we therefore suggest to perform interrogation with parallel magnet application any suspected (in)adequate shock delivery.IntroductionIn patients at risk fatal arrhythmias, an effectively mortality.1Moss A.J. Zareba W. Hall W.J. et al.Prophylactic implantation defibrillator myocardial infarction reduced ejection fraction.N Engl J Med. 2002; 346: 877-883Crossref PubMed Scopus (5589) Google Scholar,2Bardy G.H. Lee K.L. Mark D.B. al.Amiodarone for congestive heart failure.N 2005; 352: 225-237Crossref (5273) Scholar However, deliveries depict major limitation ICDs mainly induced erroneous discrimination supraventricular tachycardias oversensing P, R, T waves; myopotentials; electromagnetic interference; defective leads.3Powell B.D. Asirvatham S.J. Perschbacher D.L. al.Noise, artifact, related evaluation: ALTITUDE study.Pacing Clin Electrophysiol. 2012; 35: 863-869Crossref (46) ScholarThe (RV) lead has previously been proven efficiently reduce inadequate RV noise.4Koneru J.N. Kaszala K. Bordachar P. Shehata M. Swerdlow C. Ellenbogen K.A. Spectrum issues diagnostic alert that utilizes electrograms: clinical implications.Heart Rhythm. 2015; 12: 957-967Abstract Full Text PDF (14) Scholar, 5Beau S. Greer Ellis C.R. al.Performance detect shocks.J Interv Card 2016; 45: 225-232Crossref (12) 6Welte N. Strik Eschalier R. al.Multicenter investigation oversensing.Heart 2017; 14: 1008-1015Abstract Based on continuous comparison between channel (derived from tip-to-ring tip-to-coil signal) tip-to-can coil-to-can signal), reliably discrepant consequently, delivery can be withhold (further information displayed Figure 1).6Welte ScholarIn following presentation, report about repetitive due automatic switch into interrogation.Case reportA 46-year-old woman history sudden cardiac death idiopathic fibrillation presented our emergency department owing recurrent shocks. Prior medical summarized Table 1.Table 1Timeline history02/2007ICD fibrillationDevice: Biotronik Lumax 340 HF-TAtrial lead: Jude 1388T Tendril SDX, SN GW28169Ventricular Linox SD 65/1608/2009RV extraction reimplantation fractureNew 65/16, 1033531206/2012Elective box change low batteryDevice: Ellipse DR06/2014ICD malfunction (capacitor maintenance charging time out)Device: DR CD 2377-36C, 108328703/2022Recurrent shocksICD = cardioverter-defibrillator; RV= ventricular. Open table new tab At admission, patient reported while brushing her teeth climbing stairs. A noticed vibration was deliberately ignored patient. She denied palpitations, dizziness, syncope; also, had no anamnestic evidence ischemia decompensated failure.The physical examination normal routine blood sample revealed slightly elevated troponin levels, explained recent 12-lead electrocardiogram (ECG) showed sinus rhythm chest radiograph (Figure 2) fracture, dislocation, insulation defects.Figure 2Chest shows left pectoral location adequate positioning atrial anterolateral position apical-septal position. There fracture defects.View Large Image ViewerDownload Hi-res image Download (PPT)At beginning subsequent total 4 were delivered after placement wand, real-time ECG rhythm. Immediately, placed deactivate device. second further performed under sedation (owing panic) application, ensure inhibition.The confirmed 3), impedance (463 ohms 64 ohms, respectively), sensing amplitude (12.6 mV), pacing threshold (1.1 V / 0.4 ms) stable compared previous controls. as again repetitively first troubleshooting carried out manufacturer. This switches default interrogation. Therefore, even though detected, suppression longer took place, led 3).Figure 3A: Right inhibited (marked "RV Lead Noise"). B: Illustratively depicted signals. Owing induction inappropriately 36 joules. C: Immediately inhibit antitachycardic cardioverter-defibrillator. Near-field derived signal signal.View (PPT)Unfortunately, intracardiac perceived stored, only capacity register latest 60 episodes.As never required therapies entire carrier documented arrhythmias memory, temporarily deactivated ICD. Because enormous psychological stress extreme fear episodes, she wished explant unit, whereas old leads disconnected explanted because increased periprocedural extraction. The currently well cardiopsychological care.DiscussionTo best knowledge, describe safety by-default programmed, deactivation Although preliminary reports reliable setting algorithm,4Koneru this potentially dangerous behavior, efficient strategy needs elaborated future events.Importantly, mortality negatively affected both deliveries.7van Rees J.B. Borleffs C.J.W. de Bie M.K. al.Inappropriate shocks: incidence, predictors, impact mortality.J Am Coll Cardiol. 2011; 57: 556-562Crossref (326) Scholar,8Larsen G.K. Evans J. Lambert W.E. Chen Y. Raitt M.H. Shocks burden patients.Heart 8: 1881-1886Abstract (87) It crucial prevent arrhythmia ablation therapy, also deliveries. Additionally, resulting (inadequate) often very burdensome evoke chronic anxiety.9Morken I.M. Isaksen Karlsen B. Norekvål T.M. Bru E. Larsen A.I. Shock anxiety among cardioverter recipients tachyarrhythmia.Pacing 1369-1376Crossref (32) ScholarBesides misinterpretation tachycardias, oversensing, artefacts, provoke up 13% deliveries10Volosin K.J. Exner D.V. Wathen M.S. Sherfesee L. Scinicariello A.P. Gillberg J.M. Combining reduction strategies enhance therapy: role computer modeling.J Cardiovasc 22: 280-289Crossref (40) Scholar—for purpose shown effective. Moreover, generous surveillance remote monitoring systems prematurely identify (eg, detection artefacts) early interventions, such alternative programming revision. In patient, would have stage could avoided premature should particularly considered implanted known prone fractures, patient.11Pérez Díez D. Rubín Calvo Cuervo García Iglesias Morís De La Tassa Analysis failure Smart leads: comparative study three leads.Pacing 2018; 41: 1165-1170Crossref (4) Scholar,12Weberndörfer V. Nyffenegger T. Russi I. al.First description other contemporary high-voltage leads.J 52: 173-177Crossref (5) presenting intermittently switched mentioned manufacturer's synchronous presence noise, when withheld delivered, case. (in)appropriate delivery, propose interrogation.ConclusionThe above-presented impressively illustrates issue To signals, whenever appropriate suspected. delivery. •The IntroductionIn