title: Clinical and electrocardiographic predictors of T wave oversensing in patients with subcutaneous ICD.
abstract: BACKGROUND
  T wave oversensing (TWOS) is a major drawback of the subcutaneous implantable cardioverter defibrillator (S-ICD). Data on predictors of TWOS in S-ICD recipients are limited. We sought to investigate predictors of TWOS in a cohort of patients receiving an S-ICD at our institution.
  
  
  METHODS
  S-ICD recipients at our center were identified retrospectively and stratified based on the presence or absence of TWOS. Clinical and electrocardiographic parameters were collected and compared between the 2 groups.
  
  
  RESULTS
  Ninety-two patients underwent an S-ICD implantation at our institution between April 2010 and January 2015. Six (6.5%) patients had TWOS. These patients were younger (38.1±13.7 vs. 52.3±16.1 years, p=0.04) and had higher left ventricle ejection fractions (48.5±14.9% vs. 28.4±12.2%, p<0.01) than patients without a history of TWOS. Baseline 12-lead electrocardiogram (ECG) parameters were not different between the 2 groups. Leads I, II, and avF (which mimic the sensing vectors of the S-ICD) were further inspected to identify ECG characteristics that could predict TWOS. The QRS amplitude in ECG lead I was significantly smaller in the TWOS group than in the non-TWOS group (3.7 vs. 7.4 mV, p=0.02).
  
  
  CONCLUSIONS
  In this study, younger age, higher ejection fraction, and lower QRS amplitude were associated with TWOS. These findings could help identify patients referred for S-ICD at high-risk of TWOS.
authors.affiliation: Department of Medicine, Division of Cardiology, Section of Electrophysiology, Emory University School of Medicine, 550 Peachtree Street NE, Atlanta, GA 30308, USA.
authors.forename: Mikhael F
authors.initials: MF
authors.lastname: El-Chami
authors.affiliation: Department of Medicine, Division of Cardiology, American University of Beirut, AUBMC, Department of Internal Medicine, P.O. Box: 11-0236, Riad El-Solh, Beirut 1107 2020, Lebanon.
authors.forename: Bernard
authors.initials: B
authors.lastname: Harbieh
authors.affiliation: Department of Medicine, Division of Cardiology, Section of Electrophysiology, Emory University School of Medicine, 550 Peachtree Street NE, Atlanta, GA 30308, USA.
authors.forename: Mathew
authors.initials: M
authors.lastname: Levy
authors.affiliation: Department of Medicine, Division of Cardiology, Section of Electrophysiology, Emory University School of Medicine, 550 Peachtree Street NE, Atlanta, GA 30308, USA.
authors.forename: Angel R
authors.initials: AR
authors.lastname: Leon
authors.affiliation: Department of Medicine, Division of Cardiology, Section of Electrophysiology, Emory University School of Medicine, 550 Peachtree Street NE, Atlanta, GA 30308, USA.
authors.forename: Faisal M
authors.initials: FM
authors.lastname: Merchant
keywords: Inappropriate shocks; Subcutaneous ICD; T wave oversensing