ICD lead proarrhythmia cured by lead extraction

Lee, Joseph C.; Epstein, Laurence M.; Huffer, Linda; Stevenson, William G.; Koplan, Bruce A.; Tedrow, Usha B.

doi:10.1016/j.hrthm.2009.01.039

Cited by 35 publications

(13 citation statements)

References 18 publications

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“…Proposed mechanisms for pacing-induced VT/VF induction by the ICDs are short-long-short (S-L-S) sequences that are either pacing facilitated or pacing permitted, 57 atrial preference pacing, 58 and noncompetitive atrial pacing mode. 59 When the paced QRS morphology and VT morphology are similar, one should consider mechanical irritation from the lead as a potential mechanism of VT. 60 Studies aimed at reducing S-L-S sequences by using rate-smoothing algorithms have not shown consistent benefit. [61][62][63] Occasionally, pacing-facilitated S-L-S VT can be due to Wenckebach upper rate response, which see ϩ1).…”

Section: Icd Proarrhythmiamentioning

confidence: 99%

Minimizing Inappropriate or “Unnecessary” Implantable Cardioverter-Defibrillator Shocks

Koneru

Swerdlow

Wood

et al. 2011

Circ: Arrhythmia and Electrophysiology

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L ife-saving shocks are the raisons d'être of implantable cardioverter-defibrillators (ICDs). Paradoxically, shocks also cause much of the morbidity associated with ICDs. Consistently, shocks reduce quality of life, 1,2 and rarely, they may cause proarrhythmia. 3,4 Additionally, shocks have been reported to be associated with excess mortality. 5 Experts disagree about whether shocks are responsible for this excess mortality, 6 but they do agree that ICDs should deliver the fewest shocks necessary to protect patients from ventricular tachycardia (VT) or ventricular fibrillation (VF).Minimizing ICD shocks requires a comprehensive approach, beginning with patient selection, 7 general medical care (eg, preventing electrolyte abnormalities), and general cardiac care (preventing ischemia and treating heart failure). It includes the use of antiarrhythmic drugs and catheter ablation both to prevent VT or supraventricular tachycardia (SVT) and to control the ventricular rate in atrial fibrillation (AF) as well as the appropriate choice of hardware and device programming. This review focuses on ICD features and programming to minimize shocks. OverviewFigure 1 summarizes the sequential processes required for an ICD to deliver a shock. The sense amplifiers convert the continuous electrogram (EGM) from the tip of the right ventricular (RV) lead into a series of instantaneously sensed events representing ventricular depolarization. This series of sensed events is processed by ICD algorithms, including those for initial detection; SVT-VT discrimination; and in some models of ICDs, enhancements to minimize oversensing. If the rhythm is classified as a VT, antitachycardia pacing (ATP) can be delivered. The ICD then performs a redetection process, which results in determination that the devicedefined VT either has terminated or persists. If VT is redetected, the process iterates until all programmed ATPs are delivered. The ICD then charges the high-voltage capacitors, during which time a final round of ATP may be delivered. After capacitor charging, the ICD confirms that VT/VF is present before delivering a shock. Each step provides opportunities to minimize unnecessary shocks. Although Figure 1 shows the ICD process, we consider features and programming in the approximate order that most electrophysiologists program ICDs: (1) rate and duration for initial detection, (2) SVT-VT discrimination, (3) ATP and shock strength, (4) redetection/confirmation, and (5) sensing enhancements.Historically, shocks were classified as appropriate if delivered during VT/VF and inappropriate if delivered during other rhythms. However, some shocks delivered during VT may be avoided by programming ATP or permitting nonsustained VT to spontaneously terminate. In this review, we classify shocks as either necessary to ensure patient safety or unnecessary. Necessary shocks are those that terminate ventricular tachyarrhythmias that would not spontaneously terminate or cannot be terminated by ATP. Unnecessary shocks include those that have been traditional...

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Section: Icd Proarrhythmiamentioning

confidence: 99%

Minimizing Inappropriate or “Unnecessary” Implantable Cardioverter-Defibrillator Shocks

Koneru

Swerdlow

Wood

et al. 2011

Circ: Arrhythmia and Electrophysiology

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“…In our patient coronary angiography was normal with good biventricular systolic function. Recently, one case of proarrhythmia caused by ICD lead was also reported, which was cured by lead extraction [8]. Under the circumstances in which VT occurred in our patient, it may be inferred that redundant loop was responsible for VT and syncope in our patient.…”

Section: Discussionmentioning

confidence: 56%

An Uncommon Ventricular Tachycardia due to Inactive PPM Lead

2011

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“…This rare scenario has been described for endocardial pacing and defibrillator lead tips2, 3, 4 as well as secondary to the lead shaft itself 5, 6, 7. It also has been documented with fractured and migrated epicardial leads in the setting of perforation 8, 9.…”

Section: Discussionmentioning

confidence: 93%