Inappropriate discharge of an implantable cardioverter defibrillator during atrial flutter and intermittent ventricular antibradycardia pacing.
BACKGROUND
Inappropriate discharges of an implantable cardioverter defibrillator (ICD) are troublesome to the patient and sometimes a difficult task for the physician trying to identify and treat the cause.


RESULTS
For the first time, we report a mechanism of inappropriate ICD discharges during episodes of atrial flutter with a slow ventricular response and intermittent antibradycardia pacing. The episodes occurred in two patients and were triggered by the unique sensing algorithm of the Ventritex Cadence V-100 in combination with the tripolar CPI Endotak 072 transvenous defibrillation lead, which provides integrated bipolar sensing.


CONCLUSIONS
Besides treatment of the underlying arrhythmia, reprogramming of the device, an electrode position far away from the atria, and true bipolar sensing will enhance the performance of ICD systems with respect to the episodes described here. In addition, more flexible sensing algorithms may, in the future, prevent this overall rare complication.
Peters
W
W
Medizinische Klinik and Institut für Röntgendiagnostik der Universität Würzburg, Germany. medk297@rzbox.uni-wuerzburg.de
Kowallik
P
P
Wittenberg
G
G
Scholl
C
C
Meesmann
M
M
D000368:Aged; D000465:Algorithms; D001282:Atrial Flutter / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D001919:Bradycardia / Q000503:physiopathology*; D002304:Cardiac Pacing, Artificial / Q000009:adverse effects*; D017147:Defibrillators, Implantable / Q000009:adverse effects*; D004554:Electric Countershock / Q000009:adverse effects* / Q000295:instrumentation; D004562:Electrocardiography; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000150:complications