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Mechanisms of Inappropriate Defibrillator Therapy in a Modern Cohort of Remotely Monitored Patients
Author(s) -
SHAH HEMAL,
MEZU URE,
PATEL DIVYANG,
FLANIGAN SUSAN,
HREYBE HAITHAM,
ADELSTEIN EVAN,
JAIN SANDEEP,
LANG VOLKER,
SABA SAMIR
Publication year - 2013
Publication title -
pacing and clinical electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.686
H-Index - 101
eISSN - 1540-8159
pISSN - 0147-8389
DOI - 10.1111/pace.12101
Subject(s) - medicine , cohort , medical emergency , intensive care medicine , cardiology , emergency medicine
Defibrillator (ICD) technology and monitoring are evolving rapidly. We investigated the mechanisms of inappropriate ICD therapies in a modern cohort of patients followed at our institution via remote monitoring. Methods From September 2009 to March 2011, a total of 2,050 ICD patients (19,600 patient‐months) were remotely followed. All events (shocks and antitachycardia pacing) were adjudicated by arrhythmia specialists. Results A total of 249 patients received ICD therapy (34% inappropriate therapy). Inappropriate ICD shocks affected 33 (1.6%) patients. There were a total of 249 inappropriate episodes in 85 patients. Supraventricular tachycardia (SVT) with 1:1 atrioventricular association was the predominant mechanism accounting for 133 episodes in 50 patients, followed by atrial fibrillation (97 episodes in 27 patients). T‐wave oversensing (16 episodes in five patients), electromagnetic interference (two episodes in two patients), and ectopic beats (one episode in one patient) accounted for a small proportion of events. There were 35 arrhythmic episodes in five patients that could not be classified, all in patients with single‐chamber devices. There were no differences in these results by device manufacturer. Conclusions Despite many technological advances, inappropriate ICD shocks still occur but at very low rates and SVT with 1:1 atrioventricular association represents their most common mechanism.