An Inappropriate Shock Case Early after Implantation of a Subcutaneous Cardiac Defibrillator by Subcutaneous Entrapped Air

Taguchi, Yuka; Ishikawa, Toshiyuki; Matsumoto, Katsumi; Ogino, Yutaka; Matsushita, Hirooki; Iguchi, Kenta; Hosoda, Junya

doi:10.1536/ihj.17-117

Cited by 12 publications

(15 citation statements)

References 5 publications

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“…6) Taguchi, et al reported an inappropriate shock due to entrapped subcutaneous air early after an S-ICD implantation. 7) Myopotential oversensing may tend to occur more in S-ICD patients than in transvenous ICD (TV-ICD) patients, because an S-ICD senses subcutaneous signals from the two sensing electrodes, or from either electrode and the generator, and has a lower minimum sensibility of 0.08 mV than a TV-ICD. Furthermore, low Rwave signals are likely to increase the risk of inappropriate shocks due to myopotential oversensing.…”

Section: Discussionmentioning

confidence: 99%

Subcutaneous Implantable Cardioverter Defibrillator Lead Repositioning for Preventing Inappropriate Shocks Due to Myopotential Oversensing in a Post-Fulminant Myocarditis Patient

2019

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A 28-year-old female presented with fulminant lymphocytic myocarditis. She developed cardiogenic shock, frequent sustained ventricular tachycardia, and fibrillation (VT and VF). The left ventricular ejection fraction improved from 5% to 40% after medical therapy, but the right ventricular systolic dysfunction and enlargement persisted. In addition, sustained VTs, requiring direct current cardioversion, occurred during oral administration of amiodarone following intravenous amiodarone, even after percutaneous stellate ganglion block. Standard body surface electrocardiogram (ECG) screening for an implantation of a subcutaneous implantable cardioverter-defibrillator (S-ICD) (EMBLEM S-ICD, Boston Scientific, Marlborough, MA, USA) demonstrated that two of the three sensing vectors were eligible in spite of very low-amplitude QRS complexes in the body surface ECGs. After implantation of the S-ICD, the patient experienced repetitive, inappropriate shocks due to pectoral myopotential oversensing, which could not be resolved by reprogramming the device settings. Thus, the S-ICD lead was changed from the standard left parasternal position to the midline of the sternum to reduce muscular noise due to myopotentials. Thereafter, the patient experienced appropriate ICD shocks for sustained VT and VF but no inappropriate ICD sensing or shocks. Lead repositioning may be one of the feasible solutions in S-ICD patients with low-amplitude QRS complexes and inappropriate shocks due to myopotential oversensing which cannot be resolved by reprogramming the device settings. (Int Heart J 2019; 60: 466-469)

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Section: Discussionmentioning

confidence: 99%

Subcutaneous Implantable Cardioverter Defibrillator Lead Repositioning for Preventing Inappropriate Shocks Due to Myopotential Oversensing in a Post-Fulminant Myocarditis Patient

2019

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“…It was reported that young patients with primary electrical diseases were at an increased risk of inappropriate shocks; 25% of the patients received inappropriate shocks due to T-wave oversensing by S-ICDs. 10,11) We can predict the sensing abnormality of the S-ICD by preoperative ECG screening. In the preoperative screening test of our patient, the QRS-T complexes became ineligible based on the criteria in two of the three vectors during exercise.…”

Section: Discussionmentioning

confidence: 99%

Replacement of an Implantable Cardioverter-Defibrillator (ICD) with a New Standard Subcutaneous ICD System in a Patient with Jervell and Lange-Nielsen Syndrome

et al. 2019

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A 7-year-old female suffering from syncope attacks and deafness was genetically diagnosed with Jervell and Lange-Nielsen syndrome (JLNS). A transvenous-designed shock lead and implantable cardioverterdefibrillator (ICD) were atypically implanted subcutaneously, because the patient's body was small. Six years after implantation, we confirmed the patient's eligibility for a subcutaneous ICD (S-ICD) based on electrocardiogram screening. The implanted ICD system was replaced with a new standard S-ICD system. Implantation of the S-ICD may be considered a reliable and safe option in young patients with JLNS, even if their electrocardiograms show remarkable prolongation of the QT interval and T-wave alternans.

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“…Therefore, postoperative lateral chest fluoroscopy for confirmation of an optimal lead position is crucial for shock efficacy. Moreover, a chest X‐ray aims to rule out entrapped subcutaneous air bubbles around the lead, which might induce “baseline wandering” (undulating ECG baseline) and oversensing with the potential risk of inappropriate shocks in the first days after implantation 39,40 . Thus, before introducing the lead into the peel‐away‐sheath, it is highly recommended to flush the lumen with liquid (eg, saline solution) in order to avoid air bubble entrapment.…”

Section: Implantation Issues Of Ntv‐icdmentioning

confidence: 99%

State‐of‐the‐art consensus on non‐transvenous implantable cardioverter‐defibrillator therapy

Schukro

Santer

Prenner

et al. 2020

Clinical Cardiology

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Within the last decade, implantable cardioverter-defibrillator (ICD) systems with nontransvenous leads were developed in order to minimize complications related to the cardiovascular position of transvenous ICD leads. This national expert consensus gives an overview of potential indications for the implantation of non-transvenous ICD systems, and provides specific recommendations for implantation, follow-up, and complication management in patients with subcutaneous ICD. Regarding particular issues like the necessity for shock efficacy testing, or the clinical outcome as compared to transvenous ICD, randomized data are expected in the near future.

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An Inappropriate Shock Case Early after Implantation of a Subcutaneous Cardiac Defibrillator by Subcutaneous Entrapped Air

Cited by 12 publications

References 5 publications

Subcutaneous Implantable Cardioverter Defibrillator Lead Repositioning for Preventing Inappropriate Shocks Due to Myopotential Oversensing in a Post-Fulminant Myocarditis Patient

Subcutaneous Implantable Cardioverter Defibrillator Lead Repositioning for Preventing Inappropriate Shocks Due to Myopotential Oversensing in a Post-Fulminant Myocarditis Patient

Replacement of an Implantable Cardioverter-Defibrillator (ICD) with a New Standard Subcutaneous ICD System in a Patient with Jervell and Lange-Nielsen Syndrome

State‐of‐the‐art consensus on non‐transvenous implantable cardioverter‐defibrillator therapy

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