title: Intradevice interaction in a dual chamber implantable cardioverter defibrillator preventing ventricular tachyarrhythmia detection.
abstract: Failure to detect ventricular tachycardia and/or ventricular fibrillation by implantable cardioverter defibrillators (ICDs) is a rare but serious problem. We report a case of failure to detect an episode of induced ventricular tachycardia by a dual chamber ICD, due to abbreviation of ventricular detection window secondary to programmed pacing parameters and a rate-smoothing algorithm. In this patient, the intradevice interaction was corrected by programming rate-smoothing off. This report highlights the potentially lethal consequences of critical timing relationships among the pacing function, arrhythmia detection, and the characteristics of the arrhythmia when using a modern dual chamber ICD. Physicians responsible for patients with ICDs must be aware of such interactions.
authors.affiliation: Division of Cardiology, UCLA Medical Center, UCLA School of Medicine, Los Angeles, California, USA.
authors.forename: K
authors.initials: K
authors.lastname: Shivkumar
authors.forename: Z
authors.initials: Z
authors.lastname: Feliciano
authors.forename: N G
authors.initials: NG
authors.lastname: Boyle
authors.forename: I
authors.initials: I
authors.lastname: Wiener
mesh_terms: D000465:Algorithms; D016477:Artifacts; D002304:Cardiac Pacing, Artificial / Q000009:adverse effects*; D017147:Defibrillators, Implantable / Q000009:adverse effects*; D004868:Equipment Failure; D005260:Female; D006801:Humans; D008875:Middle Aged; D012984:Software; D017180:Tachycardia, Ventricular / Q000175:diagnosis*