Noise, Artifact, and Oversensing Related Inappropriate ICD Shock Evaluation: ALTITUDE NOISE Study

Powell, Brian D.; Asirvatham, Samuel J.; Perschbacher, L B S David; Jones, Paul; Cha, Yong‐Mei; Cesario, David A.; Cao, Michael; Gilliam, F. Roosevelt; Saxon, Leslie A.

doi:10.1111/j.1540-8159.2012.03407.x

Cited by 58 publications

(37 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Excluding recalled leads, ventricular oversensing accounts for less than 10% of inappropriate shocks, but it often results in repetitive shocks and severe symptoms [82,[142][143][144]. Recently introduced features reduce inappropriate therapies from oversensing of physiologic T waves and nonphysiologic signals related to pace-sense lead failures as discussed below.…”

Section: Ventricular Oversensingmentioning

confidence: 99%

“…One manufacturer provides an algorithm that withholds therapy after rate and duration criteria for VT/VF are fulfilled if a specific pattern of T-wave oversensing is identified [146]. T-wave oversensing rates vary based on device design; using an appropriate high band-pass filter results in very low rates of T-wave oversensing [142]. Because T-wave oversensing is unpredictable, features that minimize T-wave oversensing should be enabled proactively at implant, providing they do not cause undersensing in VF [146].…”

Section: Programming To Reduce T-wave Oversensingmentioning

confidence: 99%

See 1 more Smart Citation

2015 HRS/EHRA/APHRS/SOLAECE expert consensus statement on optimal implantable cardioverter-defibrillator programming and testing

et al. 2016

View full text Add to dashboard Cite

Section: Ventricular Oversensingmentioning

confidence: 99%

Section: Programming To Reduce T-wave Oversensingmentioning

confidence: 99%

2015 HRS/EHRA/APHRS/SOLAECE expert consensus statement on optimal implantable cardioverter-defibrillator programming and testing

et al. 2016

View full text Add to dashboard Cite

“…However, this is extremely important in these patients because of the fact that T-wave amplitude is significantly higher than that in non-BrS patients. 18,19 This question has been specifically addressed in the present study. As we speculated, the use of true bipolar leads in this patient population was associated with a greater incidence of T-wave oversensing than was use of integrated bipolar leads.…”

Section: Discussionmentioning

confidence: 99%

T-Wave Oversensing in Patients With Brugada Syndrome: True Bipolar Versus Integrated Bipolar Implantable Cardioverter Defibrillator Leads

Rodríguez‐Mañero

Asmundis

Sacher

et al. 2015

Circ: Arrhythmia and Electrophysiology

View full text Add to dashboard Cite

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 2013were 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. Rodríguez-Mañero et al T-Wave Oversensing in Brugada Syndrome 793oversensing when compared with integrated bipolar leads, probably because of greater variations in R-wave amplitude. 3,4 This could be of extreme importance in BrS because T-wave oversensing in this population has been reported to be more frequent. 5We aimed to compare the incidence of T-wave oversensing in patients with BrS according to the type of ICD lead (integrated bipolar [coil plus distal lead electrode] versus dedicated bipolar). MethodsAll patients diagnosed with BrS and implanted with an ICD in 10 tertiary hospitals between 1993 and 2013 were included in the study. The diagnosis was made after an episode of aborted sudden cardiac arrest, during evaluation of syncope, in asymptomatic patients with a suggestive ECG pattern recorded during routine examination, or as a consequence of familial screening after the diagnosis of BrS in a family member. This registry was approved by the institutional review committee, and the subjects gave informed consent.Patients were included in the study if they had a type 1 Brugada pattern on ECG at baseline on at least 1 occasion or after provocation with a class I antiarrhythmic drug (determined by its availability in the participating hospitals; ajmaline, pilsicainide, flecainide, or procainamida...

show abstract

“…Causes of inappropriate discharge include external noise, atrial dysrhythmias or oversensing, muscle myopotentials, lead-connector or mechanical faults, and electromagnetic interference (EMI). 4 Inappropriate discharge for improperly sensed atrial dysrhythmias remains relatively frequent; however, advanced technological specifications used in the production and programming of newer devices have minimized EMI as a cause of inappropriate discharge.…”

Section: Discussionmentioning

confidence: 99%

Inappropriate Implantable Cardioverter-Defibrillator Shocks Attributed to Alternating-Current Leak in a Swimming Pool

Makaryus

Angert-Gilman²,

Yacoub³

et al. 2014

Texas Heart Institute Journal

View full text Add to dashboard Cite

Attributed to Alternating-Current Leak in a Swimming Pool Implantable cardioverter-defibrillators (ICDs) I mplantable cardioverter-defibrillators (ICDs) provide primary and secondary prevention of sudden cardiac death in patients who are predisposed to malignant ventricular arrhythmias.1-3 Despite the clinical efficacy and improved technical specifications of newer ICDs, inappropriate shocks can still affect patients who have implanted devices. We review the case of a patient whose inappropriate ICD shocks were most likely caused by the leakage of small amounts of alternating current in a swimming pool. Case ReportA 63-year-old man with a history of atrial fibrillation, coronary artery disease, myocardial infarction, multivessel coronary artery bypass grafting, and ischemic cardiomyopathy presented at our electrophysiology clinic for device interrogation. Two months earlier, the patient's previous permanent pacemaker had been upgraded to a biventricular ICD: a Protecta XT model D314TRG CRT-D ( The patient had experienced 2 distinct device discharges immediately after jumping into a swimming pool while vacationing in St. Lucia approximately 2 weeks before the current presentation. He described no prodromal symptoms, chest pain, palpitations, dizziness, syncope, or aftereffects. A cardiologist in St. Lucia had ruled out ischemia, heart failure, and electrolyte disturbances.Interrogation of the ICD revealed 2 shocks for electrical activity that the device had interpreted as ventricular fibrillation (Fig. 1). The remainder of the interrogation report revealed normal function, sensing, and evaluation of thresholds by iterative output testing; 3 unrelated episodes of paroxysmal atrial fibrillation had not evoked therapy. The discharges corresponded with the times when the patient was in the swimming pool.

show abstract

Noise, Artifact, and Oversensing Related Inappropriate ICD Shock Evaluation: ALTITUDE NOISE Study

Cited by 58 publications

References 21 publications

2015 HRS/EHRA/APHRS/SOLAECE expert consensus statement on optimal implantable cardioverter-defibrillator programming and testing

2015 HRS/EHRA/APHRS/SOLAECE expert consensus statement on optimal implantable cardioverter-defibrillator programming and testing

T-Wave Oversensing in Patients With Brugada Syndrome: True Bipolar Versus Integrated Bipolar Implantable Cardioverter Defibrillator Leads

Inappropriate Implantable Cardioverter-Defibrillator Shocks Attributed to Alternating-Current Leak in a Swimming Pool

Contact Info

Product

Resources

About