Failure to Treat Life-Threatening Ventricular Tachyarrhythmias in Contemporary Implantable Cardioverter–Defibrillators

Thøgersen, Anna Margrethe; Larsen, J. M.; Johansen, Jens Brock; Abedin, Moeen; Swerdlow, Charles D.

doi:10.1161/circep.117.005305

Cited by 36 publications

(18 citation statements)

References 24 publications

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“…Recently, Thøgersen et al. reported on 10 cases of failure to treat life‐threatening ventricular tachyarrhythmias in contemporary implantable defibrillators (premature VF termination in two cases, absence of VF detection in five cases, absence of VT detection with subsequent degeneration to VF with undersensing in two cases, and recurrent VF with progressive signal degeneration in one case) . Our case series of 24 patients adds to these reports and describes scenarios and risk factors for failed ventricular tachyarrhythmia detection.…”

Section: Discussionmentioning

confidence: 65%

“…The mechanisms of underdetection of VA contributing to our six schematic scenarios have been reported previously. 9,18 Our scenarios have the advantage that they (1) may clarify the heart of the matter of a complex problem, (2) assess its frequency, and (3) may hint at a solution.…”

Section: Scenarios Of Failed Detection Of Life-threatening Ventriculamentioning

confidence: 99%

“…A matter of concern is the anecdotal reports of sudden cardiac death despite a functional defibrillator . In this report, we describe another 24 patients with a fatal or near‐fatal arrhythmic event due to failure to detect ongoing life‐threatening ventricular tachyarrhythmias (VAs).…”

Section: Introductionmentioning

confidence: 98%

“…Anguera et al reported a patient with sudden death due to PVT with an average cycle length of 329 ms that remained undetected as a consequence of undersensing due to intermittent high-amplitude R waves 6. Recently, Thøgersen et al reported on 10 cases of failure to treat life-threatening ventricular tachyarrhythmias in contemporary implantable defibrillators (premature VF termination in two cases, absence of VF detection in five cases, absence of VT detection with subsequent degeneration to VF with undersensing in two cases, and recurrent VF with progressive signal degeneration in one case) 9.…”

mentioning

confidence: 99%

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Failure to detect life‐threatening arrhythmias in ICDs using single‐chamber detection criteria

Stroobandt

Duytschaever

Strisciuglio

et al. 2019

Pacing Clinical Electrophis

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Background There are anecdotal reports of sudden death despite a functional implantable cardioverter defibrillator (ICD). We sought to describe scenarios leading to fatal or near‐fatal outcome due to inappropriately inhibited ICD therapy in devices programmed with single‐chamber detection criteria. Methods Programmed settings, episode lists, and intracardiac electrograms from 24 patients with a life‐threatening event (n = 12) or fatal outcome (n = 12) related to failed ventricular arrhythmia detection were used to clarify the underlying scenario. Results Fifty episodes of failed ventricular arrhythmia detection were identified and categorized into six scenarios: (1) spontaneous ventricular tachycardia (VT) or ventricular fibrillation (VF) with a rate below the detection limits, (2) misclassification of polymorphic VT (PVT) or VF as supraventricular tachycardia (SVT), (3) misclassification of VT/VF as cluster of nonsustained VT episodes, (4) misclassification of monomorphic VT (MVT) as SVT, (5) inappropriate shock abortion, and (6) false termination detection. These scenarios occurred respectively 6, 9, 3, 9, 8, and 15 times. In 9/9 (100%) patients with PVT/VF classified as SVT, rate stability was active for rates ranging from 222 to 250 beats/min. MVT detected as SVT was due to the sudden onset criterion in 7/9 (78%) patients and twice a consequence of the rate stability criterion active for rates ranging from 200 to 250 beats/min. Conclusion We describe six scenarios leading to failure of ventricular arrhythmia detection in a single‐chamber detection setting withholding life‐saving therapy. These scenarios are more likely to occur with high‐rate programming and long detection times, especially if combined with rate stability and sudden onset.

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Section: Discussionmentioning

confidence: 65%

Section: Scenarios Of Failed Detection Of Life-threatening Ventriculamentioning

confidence: 99%

Section: Introductionmentioning

confidence: 98%

mentioning

confidence: 99%

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Failure to detect life‐threatening arrhythmias in ICDs using single‐chamber detection criteria

Stroobandt

Duytschaever

Strisciuglio

et al. 2019

Pacing Clinical Electrophis

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“…With recent advances focused on reducing unnecessary ICD shocks, Thogersen et al 37 question the appropriateness of generic programming recommendations for all ICD manufacturers. They report 10 individuals whose ICD failed to treat VF despite otherwise normal function due predominantly to interaction between programming of fast detection rates and manufacturer-specific detection algorithms.…”

Section: Optimization Of Icd Programmingmentioning

confidence: 99%

Year in Review in Cardiac Electrophysiology

Tzou

Hussein

Madhavan

et al. 2018

Circ: Arrhythmia and Electrophysiology

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1 In the past year, there have been key advances in our understanding of arrhythmia mechanisms and diagnosis and important new therapies. We have seen advances in basic cardiac electrophysiology with demonstration of optogenetic targeting of atrial fibrillation (AF) rotors, induced pluripotent stem cell-based biological pacemakers, small-conductance Ca 2+ -activated K + (SK) channels as targets for AF treatment, and reductions in inward rectifier potassium current in promoting ventricular fibrillation. Hand-held ECG devices and implantable loop recorders have been shown to detect subclinical AF. Catheter ablation of AF in patients with left ventricular dysfunction improves outcomes compared with medical therapy. Both hybrid thoracoscopic surgical and catheter ablation procedures and off-pump surgery for AF have demonstrated efficacy. Anticoagulation with uninterrupted dabigatran had a lower major bleeding rate compared with uninterrupted warfarin after AF ablation. Studies have examined optimizing access to automatic external defibrillators by identifying optimal locations for placement and possibility of using a drone delivery network. In long-QT syndrome, there are advances in understanding of ECG predictors of arrhythmic events, the role of the role of gene variants in conferring arrhythmic risk, and effect of age and sex on QTc interval. There are numerous advances in the treatment of ventricular tachycardia, including noninvasive cardiac radiation. Catheter ablation and implantable devices continue to demonstrate effectiveness in patients with congenital heart disease.In the past year, there have been numerous ground-breaking discoveries and observations that illustrate the vibrancy and promise of our field. In this review, we have tried to capture articles published in the year 2017 of particular interest to cardiac electrophysiologists. Although we have focused on articles from our journal, we have captured many of the most impactful articles in numerous other journals. We apologize for omitting a large number of other important articles that cannot be included in this review because of space limitations. We have placed some of these in our Data Supplement. BASIC ELECTROPHYSIOLOGY BradyarrhythmiasThe search for new biological therapies for bradycardia met with recent progress as human keratinocytes genetically reprogrammed into electrically unstable cardiomyocytes were shown to persist and provide continued catecholaminergic-responsive pacing for 13 weeks after subepicardial injection into immunosuppressed dogs at the time of atrioventricular (AV) node ablation.1 Although only 40% to 80% of the beats matched the site of cell injection, this is first study to test a human induced pluripotent stem cell-based biological pacemaker in a large animal model of heart block and represents an important step forward in biological pacing.

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