Causes of ventricular oversensing in implantable cardioverter-defibrillators: implications for diagnosis of lead fracture.
BACKGROUND
Implantable cardioverter-defibrillator (ICD) ventricular oversensing may result in inappropriate therapy, which may be triggered by lead/connection issues that require surgical revision or physiologic oversensing that may be resolved with reprogramming. The sensing integrity counter (SIC) is an oversensing diagnostic that increments for very rapid ventricular intervals < or =130 ms.


OBJECTIVE
The purpose of this study was to determine the causes of a high SIC and the ability of additional diagnostics to differentiate lead/connection issues from other causes of oversensing for patients with normal impedance.


METHODS
Frequent SICs were identified in patients during routine follow-up visits. To diagnose the cause of oversensing, patients wore a modified 24-hour digital Holter monitor that recorded ECG, ventricular electrogram, and the ICD Marker Channel (Medtronic). Recordings were reviewed to determine the causes of oversensing. Patients with confirmed oversensing and adequate data were analyzed. The number of SICs per day and the presence of a nonsustained tachycardia (NST) episode with ventricular mean cycle length <220 ms were retrieved from stored ICD data.


RESULTS
Forty-eight patients had a median of 13 SICs/day. Presumed lead/connection issues occurred in 23% of patients, whereas physiologic oversensing occurred in 77% of patients. A rapid NST was recorded more commonly in patients with lead/connection issues than in those without (9/11 vs 1/37; P < .0001).


CONCLUSIONS
Oversensing resulting in frequent, very short intervals typically are caused by either lead/connection issues or physiologic signals. The additional finding of rapid NSTs usually indicates a lead/connection issue, even in the absence of impedance abnormalities.
Gunderson
Bruce D
BD
Medtronic, Inc., Minneapolis, Minnesota, USA.
Swerdlow
Charles D
CD
Wilcox
Jay M
JM
Hayman
Jean E
JE
Ousdigian
Kevin T
KT
Ellenbogen
Kenneth A
KA
D017147:Defibrillators, Implantable / Q000009:adverse effects*; D004554:Electric Countershock / Q000009:adverse effects*; D004562:Electrocardiography; D015716:Electrocardiography, Ambulatory; D004567:Electrodes, Implanted; D004867:Equipment Design; D004868:Equipment Failure; D019544:Equipment Failure Analysis; D004869:Equipment Safety; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D017180:Tachycardia, Ventricular / Q000175:diagnosis / Q000628:therapy*; D013686:Telemetry; D014693:Ventricular Fibrillation / Q000175:diagnosis / Q000517:prevention & control*; D018879:Ventricular Premature Complexes