Moisés Rodríguez-Mañero1, Carlo de Asmundis2, Frédéric Sacher2, Elena Arbelo2, Vincent Probst2, Jesús Castro-Hevia2, Philippe Maury2, Anne Rollin2, Pier Lambiase2, Ignacio García-Bolao2, Gian-Battista Chierchia2, Kengo Fukushima Kusano2, Jean-Baptiste Gourraud2, Richard Schilling2, Tsukasa Kamakura2, Jose Luis Martínez-Sande2, Michel Haïssaguerre2, José Ramón González-Juanatey2, Jose Brugada2, Pedro Brugada2. 1. From the Hospital Clínico Universitario de Santiago de Compostela (CHUS), Santiago de Compostela, Spain (M.R.-M., L.M.-S., J.R.G.-J.); Department of Cardiology, Vrije Universiteit Brussel (VUB), Brussels, Belgium (C.d.A., G.-B.C., P.B.); Bordeaux University Hospital, LIRYC Institute/INSERM 1045, Bordeaux, France (F.S., M.H.); Hospital Clínic Universitario de Barcelona, Institut du Thorax, Barcelona, Spain (E.A., J.B.); CHU de Nantes, Nantes, France (V.P., J.-B.G.); Instituto de Cardiología y Cirugía Cardiovascular, La Habana, Cuba (J.C.-H.); CHU de Toulouse, Toulouse, France (P.M., A.R.); St. Bartholomew's Hospital, London, United Kingdom (P.L., R.S.); Clinica Universidad de Navarra, Pamplona, Spain (I.G.-B.); and Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan (K.F.-K., T.K.). moirmanero@gmail.com. 2. From the Hospital Clínico Universitario de Santiago de Compostela (CHUS), Santiago de Compostela, Spain (M.R.-M., L.M.-S., J.R.G.-J.); Department of Cardiology, Vrije Universiteit Brussel (VUB), Brussels, Belgium (C.d.A., G.-B.C., P.B.); Bordeaux University Hospital, LIRYC Institute/INSERM 1045, Bordeaux, France (F.S., M.H.); Hospital Clínic Universitario de Barcelona, Institut du Thorax, Barcelona, Spain (E.A., J.B.); CHU de Nantes, Nantes, France (V.P., J.-B.G.); Instituto de Cardiología y Cirugía Cardiovascular, La Habana, Cuba (J.C.-H.); CHU de Toulouse, Toulouse, France (P.M., A.R.); St. Bartholomew's Hospital, London, United Kingdom (P.L., R.S.); Clinica Universidad de Navarra, Pamplona, Spain (I.G.-B.); and Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan (K.F.-K., T.K.).
Abstract
BACKGROUND: It is thought that dedicated bipolar are more susceptible to T-wave oversensing when compared with integrated bipolar leads. This could be of extreme importance in patients with Brugada syndrome (BrS) because T-wave oversensing in this population is more frequent when compared with other implantable cardioverter defibrillator (ICD) recipients without BrS. We aimed to compare the incidence of T-wave oversensing in patients with BrS according to the type of lead (integrated bipolar versus true/dedicated bipolar). METHODS AND RESULTS: All patients diagnosed with BrS with an ICD implant in 10 tertiary hospitals between 1993 and 2013 were included in the study. A total of 480 patients were included (mean age, 45.6±14 years). During a mean follow-up of 74.9±51.7 months (median, 69; range, 2-236), 28 patients had T-wave oversensing (5.8%), leading to inappropriate shock in 18 (3.8%). All these events occurred in patients with true bipolar ICD leads (P=0.01) and in 2 patients it was solved instantaneously by changing the configuration from a dedicated to an integrated bipolar sensing configuration. In the stepwise multivariate models, only integrated bipolar ICD leads (hazard ratio, 0.34; 95% confidence interval, 0.171-0.675; P=0.002) was independent predictor of non-T-wave oversensing. CONCLUSIONS: T-wave oversensing is a potential reason of inappropriate shocks in patients with BrS receiving ICDs. In the vast majority it can be solved by reprogramming. However, in some patients it still requires invasive intervention. Importantly, incidence is significantly lower using an integrated bipolar lead system when compared with a dedicated bipolar lead system and hence the latter should be routinely used in BrS cases.
BACKGROUND: It is thought that dedicated bipolar are more susceptible to T-wave oversensing when compared with integrated bipolar leads. This could be of extreme importance in patients with Brugada syndrome (BrS) because T-wave oversensing in this population is more frequent when compared with other implantable cardioverter defibrillator (ICD) recipients without BrS. We aimed to compare the incidence of T-wave oversensing in patients with BrS according to the type of lead (integrated bipolar versus true/dedicated bipolar). METHODS AND RESULTS: All patients diagnosed with BrS with an ICD implant in 10 tertiary hospitals between 1993 and 2013 were included in the study. A total of 480 patients were included (mean age, 45.6±14 years). During a mean follow-up of 74.9±51.7 months (median, 69; range, 2-236), 28 patients had T-wave oversensing (5.8%), leading to inappropriate shock in 18 (3.8%). All these events occurred in patients with true bipolar ICD leads (P=0.01) and in 2 patients it was solved instantaneously by changing the configuration from a dedicated to an integrated bipolar sensing configuration. In the stepwise multivariate models, only integrated bipolar ICD leads (hazard ratio, 0.34; 95% confidence interval, 0.171-0.675; P=0.002) was independent predictor of non-T-wave oversensing. CONCLUSIONS: T-wave oversensing is a potential reason of inappropriate shocks in patients with BrS receiving ICDs. In the vast majority it can be solved by reprogramming. However, in some patients it still requires invasive intervention. Importantly, incidence is significantly lower using an integrated bipolar lead system when compared with a dedicated bipolar lead system and hence the latter should be routinely used in BrS cases.