Multicenter investigation of an implantable cardioverter-defibrillator algorithm to detect oversensing.
The SecureSense right ventricular (RV) lead noise discrimination algorithm is designed to detect lead fracture and other types of oversensing in order to decrease inappropriate therapy.



We studied the real-life accuracy of the SecureSense algorithm in implantable cardioverter-defibrillator (ICD) patients followed by remote monitoring across multiple centers.



Across 3 French centers, we studied 486 patients with a St Jude Medical device who were followed by remote monitoring and who had the SecureSense algorithm activated. We reviewed ≤10 of the most recent remote monitoring-transmitted electrograms of nonsustained oversensing, RV lead noise, and ventricular tachycardia/ventricular fibrillation that received therapy.



SecureSense inhibited 22 inappropriate therapies (lead dysfunction in 10 cases, P-wave oversensing in 12 cases). A total of 57 patients (12%) sent ≥1 nonsustained oversensing episode (total of 393 episodes) with multiple etiologies: noise on the near-field channel (38%), oversensing of T waves during ventricular pacing (33%), oversensing of the sinus P wave (12%), and oversensing of the paced P wave (6%). Two episodes (0.5%) of nonsustained VT were undersensed by the far-field channel. Of 336 analyzed episodes of ventricular tachyarrhythmia, 15 episodes (4%) in 4 patients were related to oversensing of intrinsic P waves in 11 episodes or oversensing of external noise due to electrical cautery for the remaining 4 episodes.



Of ICD patients equipped with SecureSense, 12% developed episodes of oversensing. The SecureSense algorithm prevented inappropriate ICD therapies with accurate diagnosis of oversensing (caused by lead dysfunction or oversensing of physiological signals). P-wave oversensing in integrated bipolar leads, electrical cautery, and electromagnetic interference are prone to be missed by SecureSense.
Haut-Lévêque Hospital, Centre Hospitalier Universitaire de Bordeaux, LIRYC Institute, Pessac, France.
Nicolas
N
Welte
Haut-Lévêque Hospital, Centre Hospitalier Universitaire de Bordeaux, LIRYC Institute, Pessac, France; Maastricht University Medical Center, Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands. Electronic address: m.strik@maastrichtuniversity.nl.
Marc
M
Strik
Centre Hospitalier Universitaire Clermont-Ferrand, Cardiology Department, Clermont-Ferrand, France.
Romain
R
Eschalier
Centre Hospitalier Universitaire de Toulouse, Toulouse, France.
Pierre
P
Mondoly
Centre Hospitalier Universitaire de Grenoble, La Tronche, France.
Pascal
P
Defaye
Haut-Lévêque Hospital, Centre Hospitalier Universitaire de Bordeaux, LIRYC Institute, Pessac, France.
Antonio
A
Frontera
Haut-Lévêque Hospital, Centre Hospitalier Universitaire de Bordeaux, LIRYC Institute, Pessac, France.
Philippe
P
Ritter
Haut-Lévêque Hospital, Centre Hospitalier Universitaire de Bordeaux, LIRYC Institute, Pessac, France.
Michel
M
Haïssaguerre
Haut-Lévêque Hospital, Centre Hospitalier Universitaire de Bordeaux, LIRYC Institute, Pessac, France.
Sylvain
S
Ploux
VCU Health, Richmond, Virginia.
Jayanthi
J
Koneru
VCU Health, Richmond, Virginia.
Kenneth A
KA
Ellenbogen
Haut-Lévêque Hospital, Centre Hospitalier Universitaire de Bordeaux, LIRYC Institute, Pessac, France.
Pierre
P
Bordachar
D000368:Aged; D000465:Algorithms; D017147:Defibrillators, Implantable / Q000009:adverse effects*; D003951:Diagnostic Errors / Q000517:prevention & control*; D004554:Electric Countershock / Q000009:adverse effects / Q000379:methods; D015716:Electrocardiography, Ambulatory / Q000009:adverse effects / Q000379:methods; D004868:Equipment Failure; D005260:Female; D005602:France; D006801:Humans; D008297:Male; D008875:Middle Aged; D058998:Remote Sensing Technology / Q000009:adverse effects / Q000379:methods; D017180:Tachycardia, Ventricular / Q000175:diagnosis / Q000628:therapy; D014693:Ventricular Fibrillation / Q000175:diagnosis / Q000628:therapy
Algorithm; Devices; Electrogram; Implantable cardioverter-defibrillator; Noise; SecureSense; St Jude Medical; Ventricular fibrillation; Ventricular tachycardia