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BackgroundPseudo-Electrical Storm (ES) is defined as recurrent inappropriate implanted cardioverter defibrillator (ICD) discharges over 24 hours. Far from being a minor complication, Pseudo-ES is usually physical and psychological harmful and potentially lethal.The most common causes of inappropriate ICD shock include supraventricular tachycardia with high ventricular response, device oversensing and mechanical malfunctions. Recurrent ICD shocks can cause myocardial injury by direct electrocution cell injury and by activation of signaling pathways in the molecular cascade of heart failure (HF), the most important of all being adrenergic neurohormonal system. Adrenergic operativity may then synergize with recurrent ventricular arrhythmias in exacerbating ventricular dysfunction and worsening HF. Sweeney et al. [1] demonstrated that electrical shocks were associated with an increased risk of death independently of underlying ventricular arrhythmia. Authors esteemed that for every delivered shock, whether appropriate or not, the risk of death increases by 20%. On the other hand, no increased risk was associated with antitachycardia pacing (ATP) therapies. Pseudo-ES does not only cause myocardial damage, but can deplete a full device battery within hours, potentially leaving the patient unprotected from life-threatening arrhythmic events.Pseudo-ES should be treated by immediate intervention to suppress ICD shocks. Moreover, inappropriate discharges from ICD should be avoided at all cost by an optimal device programming.
Inappropriate therapies due to Supraventricular tachycardiaInappropriate shocks are one of the main issues to be avoided as they cause patient discomfort, are potentially proarrhythmic, and reduce battery life. The two main causes of inappropriate shock are failure in discriminating supraventricular arrhythmias (SVA) [2][3][4][5][6][7][8][9][10][11][12][13]. Frequently SVA is associated with a fast-ventricular response leading ventricular rate to fall into VT/VF detection zone causing inappropriate therapy release. This problem occurs more frequently with single-chamber ICD that do not have atrial sensing