title: Inappropriate shock for myopotential over-sensing in a patient with subcutaneous ICD.
abstract: Inappropriate ICD shocks are common adverse events; they are mainly due to supraventricular arrhythmias and secondly are related to noise, undersensing, oversensing, device malfunctions. We present a case of inappropriate device therapy due to myopotential oversensing in a patient with a subcutaneous ICD (s-ICD). A 58 years old male with an s-ICD during the device interrogation showed a previous episode of suspected sustained ventricular tachycardia at 210 bpm, which was effectively treated with ICD shock. The patient experienced the electrical shock while holding a big gas-cylinder in his arms. The EGM analysis revealed many irregular ventricular signals of low amplitude lasting for 24 s and interrupted by the shock. The device showed no malfunctions. This is the first case report of inappropriate S-ICD shock related to myopotential over-sensing. By recording intracardiac EGM, we demonstrated that the noise was created by the activity of the pectorals muscles.
authors.affiliation: Institute of Cardiology, University of Bologna, Pol. S.Orsola-Malpighi, Bologna, Italy. Electronic address: alessandro.corzani@gmail.com.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Corzani
authors.affiliation: Institute of Cardiology, University of Bologna, Pol. S.Orsola-Malpighi, Bologna, Italy.
authors.forename: Matteo
authors.initials: M
authors.lastname: Ziacchi
authors.affiliation: Institute of Cardiology, University of Bologna, Pol. S.Orsola-Malpighi, Bologna, Italy.
authors.forename: Mauro
authors.initials: M
authors.lastname: Biffi
authors.affiliation: Institute of Cardiology, University of Bologna, Pol. S.Orsola-Malpighi, Bologna, Italy.
authors.forename: Igor
authors.initials: I
authors.lastname: Diemberger
authors.affiliation: Institute of Cardiology, University of Bologna, Pol. S.Orsola-Malpighi, Bologna, Italy.
authors.forename: Cristian
authors.initials: C
authors.lastname: Martignani
authors.affiliation: Institute of Cardiology, University of Bologna, Pol. S.Orsola-Malpighi, Bologna, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Boriani
mesh_terms: D002311:Cardiomyopathy, Dilated / Q000150:complications* / Q000503:physiopathology / Q000628:therapy; D017147:Defibrillators, Implantable / Q000009:adverse effects*; D004562:Electrocardiography; D004868:Equipment Failure; D006339:Heart Rate / Q000502:physiology*; D006352:Heart Ventricles / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017180:Tachycardia, Ventricular / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*
keywords: Device inappropriate shocks; Implantable cardioverter defibrillators; Myopotential over-sensing; Subcutaneous ICD; Ventricular tachyarrhythmia
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