Postmortem analysis of ICDs allows tracking of lead impedance changes, which correlate with the day of death. The rise in postmortem impedances should not be interpreted as contributing to the mode of death.
Ventricular alternans may be more common than realized in ICD patients with VT. The correlation of VEGM alternans with the surface electrocardiogram remains unknown. Although QRS alternans itself as an electrical pattern is generally benign, its cause may not be, as illustrated in our patient with CPVT. Furthermore, associated cycle length alternans or undersensing of the smaller alternans component may complicate ICD therapy.
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