Inappropriate shocks in a patient with a subcutaneous implantable cardioverter- defibrillator Sana M. Al-Khatib, MD, MHS, FHRS, Sasmrita Belbase, NP,

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Presentation transcript:

Inappropriate shocks in a patient with a subcutaneous implantable cardioverter- defibrillator Sana M. Al-Khatib, MD, MHS, FHRS, Sasmrita Belbase, NP, Diane Sauro, NP, Gail Brock, NP, Kathleen Brink, BSN, FHRS, Kevin P. Jackson, MD HeartRhythm Case Reports Volume 2, Issue 6, Pages 478-483 (November 2016) DOI: 10.1016/j.hrcr.2016.06.006 Copyright © 2016 Heart Rhythm Society Terms and Conditions

Figure 1 A: Device settings and electrogram of inappropriate implantable cardioverter-defibrillator (ICD) shock. B: A zoomed-in image of electrogram that shows R-wave attenuation with undersensing and resultant oversensing of atrial fibrillation waves and inappropriate ICD shock. HeartRhythm Case Reports 2016 2, 478-483DOI: (10.1016/j.hrcr.2016.06.006) Copyright © 2016 Heart Rhythm Society Terms and Conditions

Figure 2 A: Patient’s posteroanterior chest radiograph. B: Patient’s lateral chest radiograph. HeartRhythm Case Reports 2016 2, 478-483DOI: (10.1016/j.hrcr.2016.06.006) Copyright © 2016 Heart Rhythm Society Terms and Conditions

Figure 3 In-depth analyses of the vector electrograms and posture (A: electrocardiogram [ECG] in supine position; B: ECG in left decubitus position) in the primary sensing configuration demonstrated that the morphology shift seen by the subcutaneous implantable cardioverter-defibrillator is consistent with what is seen in the same vector on the surface ECG. HeartRhythm Case Reports 2016 2, 478-483DOI: (10.1016/j.hrcr.2016.06.006) Copyright © 2016 Heart Rhythm Society Terms and Conditions