title: A rare type of ventricular oversensing in ICD therapy--inappropriate ICD shock delivery due to triple counting.
abstract: Irregular sensing by triple counting of wide QRS complexes resulted in inappropriate shocks in a patient with a biventricular implantable cardioverter defibrillator (ICD): A 66-year-old male patient with ischemic cardiomyopathy, left bundle branch block, and impaired left ventricular function received a biventricular ICD for optimal therapy of heart failure (CHF). Two years after implantation, the patient experienced recurrent unexpected ICD shocks without clinical symptoms of malignant tachyarrhythmia, or worsened CHF. The patient's condition rapidly worsened, with progressive cardiogenic shock and electrical-mechanical dissociation. After unsuccessful resuscitation of the patient the interrogation of the ICD showed an initial triple counting of extremely wide and fragmented QRS complexes with inappropriate shocks.
authors.affiliation: Medical Clinic, Department of Internal Medicine and Cardiology, University of Technology-Dresden, Fetscherstrasse 76,Dresden, Germany. michael.guenther2@mailbox.tu-dresden.de
authors.forename: Michael
authors.initials: M
authors.lastname: Guenther
authors.forename: Thomas P
authors.initials: TP
authors.lastname: Rauwolf
authors.forename: Manja
authors.initials: M
authors.lastname: Bock
authors.forename: Ruth H
authors.initials: RH
authors.lastname: Strasser
authors.forename: Martin U
authors.initials: MU
authors.lastname: Braun
mesh_terms: D002037:Bundle-Branch Block / Q000503:physiopathology; D009202:Cardiomyopathies / Q000503:physiopathology; D017147:Defibrillators, Implantable; D017809:Fatal Outcome; D005260:Female; D006333:Heart Failure / Q000628:therapy*; D006801:Humans; D008297:Male; D011475:Prosthesis Failure; D013610:Tachycardia / Q000209:etiology*; D016277:Ventricular Function, Left