title: Mechanisms of Undersensing by a Noise Detection Algorithm That Utilizes Far-Field Electrograms With Near-Field Bandpass Filtering.
abstract: Implantable cardioverter defibrillators (ICDs) must establish a balance between delivering appropriate shocks for ventricular tachyarrhythmias and withholding inappropriate shocks for lead-related oversensing ("noise"). To improve the specificity of ICD therapy, manufacturers have developed proprietary algorithms that detect lead noise. The SecureSenseTMRV Lead Noise discrimination (St. Jude Medical, St. Paul, MN, USA) algorithm is designed to differentiate oversensing due to lead failure from ventricular tachyarrhythmias and withhold therapies in the presence of sustained lead-related oversensing.
  
  
  
  We report 5 patients in whom appropriate ICD therapy was withheld due to the operation of the SecureSense algorithm and explain the mechanism for inhibition of therapy in each case. Limitations of algorithms designed to increase ICD therapy specificity, especially for the SecureSense algorithm, are analyzed.
  
  
  
  The SecureSense algorithm can withhold appropriate therapies for ventricular arrhythmias due to design and programming limitations. Electrophysiologists should have a thorough understanding of the SecureSense algorithm before routinely programming it and understand the implications for ventricular arrhythmia misclassification.
authors.affiliation: Virginia Commonwealth University/Pauley Heart Center, Richmond, Virginia, USA.
authors.forename: Jayanthi N
authors.initials: JN
authors.lastname: Koneru
authors.affiliation: Cedars Sinai Heart Center, Los Angeles, California, USA.
authors.forename: Charles D
authors.initials: CD
authors.lastname: Swerdlow
authors.affiliation: Bordeaux University Hospital (CHU), Pessac, France.|IHU Liryc, Electrophysiology and Heart Modeling Institute, Pessac-Bordeaux, France.
authors.forename: Sylvain
authors.initials: S
authors.lastname: Ploux
authors.affiliation: Virginia Commonwealth University/Pauley Heart Center, Richmond, Virginia, USA.
authors.forename: Parikshit S
authors.initials: PS
authors.lastname: Sharma
authors.affiliation: Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond, Virginia, USA.
authors.forename: Karoly
authors.initials: K
authors.lastname: Kaszala
authors.affiliation: Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond, Virginia, USA.
authors.forename: Alex Y
authors.initials: AY
authors.lastname: Tan
authors.affiliation: Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond, Virginia, USA.
authors.forename: Jose F
authors.initials: JF
authors.lastname: Huizar
authors.affiliation: Geisinger Heart Institute, Wilkes-Barre, Pennsylvania, USA.
authors.forename: Pugazhendi
authors.initials: P
authors.lastname: Vijayaraman
authors.affiliation: Westside Regional Medical Center, Plantation, Florida, USA.
authors.forename: David
authors.initials: D
authors.lastname: Kenigsberg
authors.affiliation: Virginia Commonwealth University/Pauley Heart Center, Richmond, Virginia, USA.
authors.forename: Kenneth A
authors.initials: KA
authors.lastname: Ellenbogen
mesh_terms: D000368:Aged; D000465:Algorithms; D001145:Arrhythmias, Cardiac / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy*; D017147:Defibrillators, Implantable; D004554:Electric Countershock; D022062:Electrophysiologic Techniques, Cardiac / Q000379:methods*; D004868:Equipment Failure; D005260:Female; D006801:Humans; D011237:Predictive Value of Tests; D011474:Prosthesis Design; D015203:Reproducibility of Results; D012815:Signal Processing, Computer-Assisted; D059629:Signal-To-Noise Ratio; D012985:Software Design; D016896:Treatment Outcome
keywords: SecureSense algorithm; inappropriate shocks; sensing algorithm; ventricular tachycardias