Oversensing issues leading to device extraction: When subcutaneous implantable cardioverter-defibrillator reached a dead-end

• Published in: Heart rhythm Vol. 17; no. 1; pp. 66 - 74
• Main Authors: Noel, Antoine, Ploux, Sylvain, Bulliard, Samuel, Strik, Marc, Haeberlin, Andreas, Welte, Nicolas, Marchand, Hugo, Klotz, Nicolas, Ritter, Philippe, Haïssaguerre, Michel, Bordachar, Pierre
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.01.2020
• Subjects: Death, Sudden, Cardiac - etiology; Death, Sudden, Cardiac - prevention & control; Defibrillators, Implantable - adverse effects; Device Removal - methods; Electric Countershock - adverse effects; Electric Countershock - instrumentation; Electrocardiography; Equipment Failure; Female; Follow-Up Studies; Humans; Implantable cardioverter-defibrillator; Inappropriate therapy; Male; Middle Aged; Oversensing; Retrospective Studies; Subcutaneous implantable cardioverter-defibrillator; Sudden cardiac death; Ventricular Fibrillation - physiopathology; Ventricular Fibrillation - therapy; Inappropriate therapy; Oversensing; Sudden cardiac death; Implantable cardioverter-defibrillator; Subcutaneous implantable cardioverter-defibrillator
• ISSN: 1547-5271; 1556-3871
• DOI: 10.1016/j.hrthm.2019.07.004

Subcutaneous implantable cardioverter-defibrillator (S-ICD) implantations are rapidly expanding. However, the subcutaneous detection and interpretation of cardiac signals in S-ICDs is much more challenging than by conventional devices. There is a complete paradigm shift in cardiac signal sensing with subcutaneous signal detection, leading in some cases to oversensing with restricted programming options. The aim of this single-center study was to quantify and describe cases where recurring oversensing made the extraction of the device necessary. Consecutive patients (n = 108) implanted with an S-ICD in our tertiary referral hospital were considered for analysis. Clinical and remote monitoring data were analyzed. The S-ICD had to be explanted in 6 of 108 implanted patients (5.6%) because of refractory oversensing issues: myopotential oversensing, P- or T-wave oversensing, rate-dependent left bundle branch block aberrancy during exercise with R-wave double counting, and R-wave amplitude decrease after ventricular tachycardia ablation leading to noise detection. Seventeen of 108 patients experienced oversensing (15.7%): 9 patients had at least 1 inappropriate charge without a shock (8.3%), 3 patients had at least 1 inappropriate shock (2.8%), and 5 patients had both episodes (4.6%). So far, cardiologists have had to deal with transvenous ICD lead fractures, but signal oversensing without correcting programming option could be the equivalent weakness of S-ICDs, despite an adequate screening. [Display omitted]