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Changing place, changing future: Repositioning a subcutaneous implantable cardioverter-defibrillator can resolve inappropriate shocks secondary to myopotential.

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Presentation on theme: "Changing place, changing future: Repositioning a subcutaneous implantable cardioverter-defibrillator can resolve inappropriate shocks secondary to myopotential."— Presentation transcript:

1 Changing place, changing future: Repositioning a subcutaneous implantable cardioverter-defibrillator can resolve inappropriate shocks secondary to myopotential oversensing  Paola Berne, MD, Graziana Viola, MD, Giovanni Motta, MD, Nicola Marziliano, BD, PhD, Valerio Carboni, BSN, Gavino Casu, MD  HeartRhythm Case Reports  Volume 3, Issue 10, Pages (October 2017) DOI: /j.hrcr Copyright © 2017 Heart Rhythm Society Terms and Conditions

2 Figure 1 A: Lateral chest radiograph after subcutaneous implantable cardioverter-defibrillator (S-ICD) implantation. B: Electrogram of S-ICD shocks. Noise from myopotential signals (red arrows) with a similar amplitude to that of QRS complexes at a heart rate of ∼90 beats/min (green arrows) leads to the incorrect detection of tachycardia (asterisk) and an inappropriate shock (single circle) that triggers ventricular fibrillation (star), which is appropriately sensed and treated by means of a second S-ICD shock (double circle). HeartRhythm Case Reports 2017 3, DOI: ( /j.hrcr ) Copyright © 2017 Heart Rhythm Society Terms and Conditions

3 Figure 2 Device interrogation before system repositioning. The primary vector (1× gain) showed less oversensing but an unstable R-wave amplitude owing to postural movements (intermittently <1 mV). Maneuvers resembling the exercise that caused the inappropriate shock lead to intermittent oversensing (asterisks). Small R-wave amplitudes were also observed in alternate and secondary vectors. HeartRhythm Case Reports 2017 3, DOI: ( /j.hrcr ) Copyright © 2017 Heart Rhythm Society Terms and Conditions

4 Figure 3 A: Lateral chest radiograph after system repositioning (can relocation only). B: Device interrogation repeating the maneuvers in the primary vector (gain setting 2×) did not show oversensing; R-wave amplitude remained constantly >1 mV even with postural changes; and there was better 1:1 beat classification (a premature ventricular contraction was also correctly discarded; see the “•” marker). HeartRhythm Case Reports 2017 3, DOI: ( /j.hrcr ) Copyright © 2017 Heart Rhythm Society Terms and Conditions

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