Avoiding inappropriate ventricular tachycardia detection due to T-wave oversensing in an implantable cardioverter defibrillator: a novel application of the electrogram width criterion.

Appropriate sensing is an essential function of an implantable cardioverter defibrillator (ICD). T-wave oversensing by an ICD can be a serious problem in some patients, causing overestimation of the heart rate, inappropriate tachyarrhythmia detection and therapy delivery. Decreasing the sensitivity or programming longer refractory periods can sometimes overcome T-wave oversensing, but these measures may interfere with the ability of the ICD to correctly detect tachyarrhythmias. This report proposes a novel application of the electrogram (EGM) width criterion using a recently introduced detection enhancement algorithm intended to improve the specificity of ventricular tachycardia detection, to avoid T-wave oversensing. Based on the course of a case with persistent T-wave oversensing and review of previously published reports, oversensing problems in ICDs and management strategies are discussed.