Implantable cardiac defibrillator lead failure or myopotential oversensing? An approach to the diagnosis of noise on lead electrograms.

The appearance of noise on electrograms (EGMs) recorded from the lead of an implantable cardioverter-defibrillator (ICD) may be owing to oversensing of myopotentials, insulation breach, conductor coil fracture, loose set screw, or electromagnetic interference from an external source. The extraneous noise may lead to inappropriate shocks or inhibition of pacing. We describe two cases of pectoral myopotentials oversensing in patients with ICD and an approach to distinguish among the various extraneous noises recorded on EGMs. A systematic approach to identify the cause of the noise is important to render an appropriate treatment, which might include simple device re-programming or require re-operation and lead revision or replacement.