Inappropriate subcutaneous implantable cardioverter-defibrillator therapy due to R-wave amplitude variation: Another challenge in device management Syeda.

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Presentation transcript:

Inappropriate subcutaneous implantable cardioverter-defibrillator therapy due to R-wave amplitude variation: Another challenge in device management Syeda A. Batul, MD, Felix Yang, MD, FHRS, Karan Wats, MBBS, Suvash Shrestha, MBBS, Yisachar J. Greenberg, MD, FHRS HeartRhythm Case Reports Volume 3, Issue 1, Pages 78-82 (January 2017) DOI: 10.1016/j.hrcr.2016.09.010 Copyright © 2016 Heart Rhythm Society Terms and Conditions

Figure 1 Subcutaneous implantable cardioverter-defibrillator interrogation strip displaying patient in sinus tachycardia. Overcounting and inappropriate therapy resulted from signal rectification in the presence of tall R waves and shift in baseline. HeartRhythm Case Reports 2017 3, 78-82DOI: (10.1016/j.hrcr.2016.09.010) Copyright © 2016 Heart Rhythm Society Terms and Conditions

Figure 2 Alternate vector selection with lowest amplitude R wave. HeartRhythm Case Reports 2017 3, 78-82DOI: (10.1016/j.hrcr.2016.09.010) Copyright © 2016 Heart Rhythm Society Terms and Conditions

Figure 3 Baseline offset with high QRS amplitude decreased the QRS/T-wave ratio and an increased predisposition to oversensing. ECG = electrocardiogram. © Boston Scientific, published with permission. HeartRhythm Case Reports 2017 3, 78-82DOI: (10.1016/j.hrcr.2016.09.010) Copyright © 2016 Heart Rhythm Society Terms and Conditions

Figure 4 Recreated oversensing event with nonzero baseline, high QRS amplitude, and slew rates during internal testing. © Boston Scientific, published with permission. HeartRhythm Case Reports 2017 3, 78-82DOI: (10.1016/j.hrcr.2016.09.010) Copyright © 2016 Heart Rhythm Society Terms and Conditions