Inappropriate shock from delayed T-wave oversensing by a subcutaneous implantable cardioverter-defibrillator after septal myectomy for hypertrophic cardiomyopathy

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Inappropriate shock from delayed T-wave oversensing by a subcutaneous implantable cardioverter-defibrillator after septal myectomy for hypertrophic cardiomyopathy Benjamin C. Salgado, MD, Rita Coram, MD, John Mandrola, MD, Rakesh Gopinathannair, MD, MA, FHRS HeartRhythm Case Reports Volume 4, Issue 9, Pages 408-411 (September 2018) DOI: 10.1016/j.hrcr.2018.06.004 Copyright © 2018 Heart Rhythm Society Terms and Conditions

Figure 1 A: A 12-lead electrocardiogram prior to septal myectomy showing sinus rhythm, left atrial enlargement, and left axis deviation with a QRS duration of 88 ms. B: A 12-lead electrocardiogram soon after septal myectomy demonstrating normal sinus rhythm, new left bundle branch block, and a QRS duration of 160 ms. HeartRhythm Case Reports 2018 4, 408-411DOI: (10.1016/j.hrcr.2018.06.004) Copyright © 2018 Heart Rhythm Society Terms and Conditions

Figure 2 A 12-lead electrocardiogram (ECG) 39 days after septal myectomy showing sinus rhythm with left bundle branch block and a QRS duration of 154 ms. Notice the taller T waves compared to the ECG done shortly after myectomy. HeartRhythm Case Reports 2018 4, 408-411DOI: (10.1016/j.hrcr.2018.06.004) Copyright © 2018 Heart Rhythm Society Terms and Conditions

Figure 3 Subcutaneous implantable cardioverter-defibrillator interrogation strip showing sinus tachycardia and inappropriate shock from T-wave oversensing. HeartRhythm Case Reports 2018 4, 408-411DOI: (10.1016/j.hrcr.2018.06.004) Copyright © 2018 Heart Rhythm Society Terms and Conditions

Supplemental Figure Panels A–C show S-ECG tracings comparing primary vector pre- and post-myectomy as well as the alternate vector following the ICD shocks. A: S-ECG at baseline (Pre-Myectomy). B: S-ECG 3 months after myectomy. C: S-ECG 2 months post-shock (sensing vector is alternate with SMARTPASS on). Note QRS axis compared to the T-wave. HeartRhythm Case Reports 2018 4, 408-411DOI: (10.1016/j.hrcr.2018.06.004) Copyright © 2018 Heart Rhythm Society Terms and Conditions

Supplemental Figure Panels A–C show S-ECG tracings comparing primary vector pre- and post-myectomy as well as the alternate vector following the ICD shocks. A: S-ECG at baseline (Pre-Myectomy). B: S-ECG 3 months after myectomy. C: S-ECG 2 months post-shock (sensing vector is alternate with SMARTPASS on). Note QRS axis compared to the T-wave. HeartRhythm Case Reports 2018 4, 408-411DOI: (10.1016/j.hrcr.2018.06.004) Copyright © 2018 Heart Rhythm Society Terms and Conditions

Supplemental Figure Panels A–C show S-ECG tracings comparing primary vector pre- and post-myectomy as well as the alternate vector following the ICD shocks. A: S-ECG at baseline (Pre-Myectomy). B: S-ECG 3 months after myectomy. C: S-ECG 2 months post-shock (sensing vector is alternate with SMARTPASS on). Note QRS axis compared to the T-wave. HeartRhythm Case Reports 2018 4, 408-411DOI: (10.1016/j.hrcr.2018.06.004) Copyright © 2018 Heart Rhythm Society Terms and Conditions