Antoine Noel1, Sylvain Ploux2, Samuel Bulliard3, Marc Strik4, Andreas Haeberlin3, Nicolas Welte3, Hugo Marchand3, Nicolas Klotz3, Philippe Ritter2, Michel Haïssaguerre2, Pierre Bordachar2. 1. Bordeaux University Hospital, Cardio-Thoracic Unit, Pessac, France. Electronic address: antoine.noel@etu.u-pec.fr. 2. Bordeaux University Hospital, Cardio-Thoracic Unit, Pessac, France; IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac - Bordeaux, France. 3. Bordeaux University Hospital, Cardio-Thoracic Unit, Pessac, France. 4. Physiology and Cardiology department, Maastricht University Medical Center, Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands.
Abstract
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.
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.
Authors: Naga Venkata K Pothineni; Tharian Cherian; Neel Patel; Jeffrey Smietana; David S Frankel; Rajat Deo; Andrew E Epstein; Francis E Marchlinski; Robert D Schaller Journal: J Innov Card Rhythm Manag Date: 2022-04-15