Usefulness of lead repositioning to improve subcutaneous electrocardiogram sensing in patients with arrhythmogenic right ventricular cardiomyopathy with subcutaneous implantable cardioverter-defibrillator

Progressive giant cell myocarditis presenting with inappropriate shocks from a subcutaneous defibrillator

“…Although our patient subsequently underwent cardiac transplantation, another method for managing the problem of poor sensing may be electrode repositioning. Although not specific to GCM, Sasaki and colleagues 13 described 2 cases of poor sensing in S-ICD systems in patients with progressive arrhythmogenic right ventricular cardiomyopathy and inappropriate shocks. In 1 case, lead repositioning under fluoroscopy was performed after mapping using the Automated Screening Tool, with an improvement in the QRS/T ratio and elimination of inappropriate shocks over a 12-month period.…”

Possibility of the Subcutaneous Implantable Cardioverter-Defibrillator for Prevention of Sudden Cardiac Death in Patients with Arrhythmogenic Right Ventricular Cardiomyopathy

“…Recently, we reported the usefulness of S-ICD lead repositioning to avoid IAS in young patients with ARVC [7]. The most important benefit of S-ICD lead repositioning is an improved S-ECG sensing due to changes in QRS amplitude of S-ECG.…”

“…However, the usefulness of S-ICD in patients with ARVC has not been established because of the low QRS amplitude of subcutaneous electrocardiogram (S-ECG) followed by the high incidence of IAS due to oversensing [5,6]. We recently reported the usefulness of S-ICD lead repositioning to avoid IAS in patients with ARVC [7]. In this chapter, we will discuss the effectiveness of S-ICD lead repositioning for young adult patients with ARVC based on our clinical experience of patients with IAS.…”