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Failure to detect life‐threatening arrhythmias in ICDs using single‐chamber detection criteria
Author(s) -
Stroobandt Roland X.,
Duytschaever Mattias F.,
Strisciuglio Teresa,
Heuverswyn Frederic E.,
Timmers Liesbeth,
Pooter Jan,
Knecht Sébastien,
Vandekerckhove Yves R.,
Kucher Andreas,
Tavernier Rene H.
Publication year - 2019
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.13610
Subject(s) - medicine , cardiology , ventricular tachycardia , ventricular fibrillation , supraventricular tachycardia , single chamber , implantable cardioverter defibrillator , sudden death , tachycardia
Abstract Background There are anecdotal reports of sudden death despite a functional implantable cardioverter defibrillator (ICD). We sought to describe scenarios leading to fatal or near‐fatal outcome due to inappropriately inhibited ICD therapy in devices programmed with single‐chamber detection criteria. Methods Programmed settings, episode lists, and intracardiac electrograms from 24 patients with a life‐threatening event (n = 12) or fatal outcome (n = 12) related to failed ventricular arrhythmia detection were used to clarify the underlying scenario. Results Fifty episodes of failed ventricular arrhythmia detection were identified and categorized into six scenarios: (1) spontaneous ventricular tachycardia (VT) or ventricular fibrillation (VF) with a rate below the detection limits, (2) misclassification of polymorphic VT (PVT) or VF as supraventricular tachycardia (SVT), (3) misclassification of VT/VF as cluster of nonsustained VT episodes, (4) misclassification of monomorphic VT (MVT) as SVT, (5) inappropriate shock abortion, and (6) false termination detection. These scenarios occurred respectively 6, 9, 3, 9, 8, and 15 times. In 9/9 (100%) patients with PVT/VF classified as SVT, rate stability was active for rates ranging from 222 to 250 beats/min. MVT detected as SVT was due to the sudden onset criterion in 7/9 (78%) patients and twice a consequence of the rate stability criterion active for rates ranging from 200 to 250 beats/min. Conclusion We describe six scenarios leading to failure of ventricular arrhythmia detection in a single‐chamber detection setting withholding life‐saving therapy. These scenarios are more likely to occur with high‐rate programming and long detection times, especially if combined with rate stability and sudden onset.