title: Use of an electrocardiographic screening tool to determine candidacy for a subcutaneous implantable cardioverter-defibrillator.
abstract: BACKGROUND
  An electrocardiographic (ECG) screening test has been developed to identify patients being considered for a totally subcutaneous implantable cardioverter-defibrillator (S-ICD) at risk for T-wave oversensing.
  
  
  OBJECTIVE
  The purpose of this study was to determine the proportion of potential S-ICD recipients who fail the ECG screening test and to identify predictors of failure.
  
  
  METHODS
  Patients who already have an ICD but are not receiving antibradycardia pacing are representative of patients who might be considered for an S-ICD. One hundred such outpatients were enrolled in the study. Surface rhythm strips were recorded along the sensing vectors of the S-ICD system and the screening template applied. Clinical and standard ECG characteristics of patients who failed the test were compared to those who passed.
  
  
  RESULTS
  Patients had the following characteristics: 72% male, age 57 ± 16 years, body mass index 29 ± 6 kg/m(2), left ventricular ejection fraction 43% ± 17%, QRS duration 109 ± 23 ms, QTc interval 447 ± 39 ms, 44% had coronary disease, and 55% had heart failure. Among the 100 patients, 8% failed the screening test. There were no differences in patient clinical characteristics and most standard ECG measurements. However, patients with T-wave inversions in standard ECG leads I, II, and aVF had a 45% chance of failing.
  
  
  CONCLUSIONS
  Eight percent of potential S-ICD patients were not eligible for the S-ICD after failing the screening test designed to identify patients susceptible to T-wave oversensing. Patients with T-wave inversions in leads I, II, and aVF on a standard ECG were 23 times more likely to fail. More work is needed in S-ICD sensing algorithms to increase patient eligibility for the S-ICD.
authors.affiliation: Division of Cardiology, Department of Medicine, Northwestern University, Chicago, Illinois.
authors.forename: Christopher A
authors.initials: CA
authors.lastname: Groh
authors.affiliation: Division of Cardiology, Department of Medicine, Northwestern University, Chicago, Illinois.
authors.forename: Shishir
authors.initials: S
authors.lastname: Sharma
authors.affiliation: Division of Cardiology, Department of Medicine, Northwestern University, Chicago, Illinois.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Pelchovitz
authors.affiliation: Division of Cardiology, Department of Medicine, Northwestern University, Chicago, Illinois.
authors.forename: Prashant D
authors.initials: PD
authors.lastname: Bhave
authors.affiliation: Division of Cardiology, Department of Medicine, Northwestern University, Chicago, Illinois.
authors.forename: John
authors.initials: J
authors.lastname: Rhyner
authors.affiliation: Division of Cardiology, Department of Medicine, Northwestern University, Chicago, Illinois.
authors.forename: Nishant
authors.initials: N
authors.lastname: Verma
authors.affiliation: Division of Cardiology, Department of Medicine, Northwestern University, Chicago, Illinois.
authors.forename: Rishi
authors.initials: R
authors.lastname: Arora
authors.affiliation: Division of Cardiology, Department of Medicine, Northwestern University, Chicago, Illinois.
authors.forename: Alexandru B
authors.initials: AB
authors.lastname: Chicos
authors.affiliation: Division of Cardiology, Department of Medicine, Northwestern University, Chicago, Illinois.
authors.forename: Susan S
authors.initials: SS
authors.lastname: Kim
authors.affiliation: Division of Cardiology, Department of Medicine, Northwestern University, Chicago, Illinois.
authors.forename: Albert C
authors.initials: AC
authors.lastname: Lin
authors.affiliation: Division of Cardiology, Department of Medicine, Northwestern University, Chicago, Illinois.
authors.forename: Rod S
authors.initials: RS
authors.lastname: Passman
authors.affiliation: Division of Cardiology, Department of Medicine, Northwestern University, Chicago, Illinois. Electronic address: bknight@nmff.org.
authors.forename: Bradley P
authors.initials: BP
authors.lastname: Knight
mesh_terms: D001145:Arrhythmias, Cardiac / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy; D016757:Death, Sudden, Cardiac / Q000517:prevention & control*; D017147:Defibrillators, Implantable; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006329:Heart Conduction System / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Defibrillator screening; Implantable cardioverter-defibrillator; Inappropriate shocks; Subcutaneous implantable cardioverter-defibrillator; T-wave oversensing