Inappropriate Shock from Subcutaneous Implantable Cardioverter-Defibrillator Caused by Electrical Remodeling After Wolff-Parkinson-White Ablation

Abstract

Hypertrophic cardiomyopathy (HCM) and Wolff-Parkinson-White syndrome have been associated with sudden cardiac death. A subcutaneous implantable cardioverter-defibrillator (S-ICD) is an effective device used to reduce the risk of sudden cardiac death in these patients. The most common cause of inappropriate shocks with S-ICD is T-wave oversensing. We present the case of a 19-year-old man with repeated shocks from his S-ICD. This case highlights some of the sensing issues related to the S-ICD that can result in inappropriate shocks. A vector change may have occurred after T-wave remodeling, post accessory pathway ablation, and loss of R-waves due to HCM scar progression, leading to this consequence.

Hyperkalemia Causing Inappropriate Subcutaneous Implantable Cardioverter Defibrillator Shocks in a Patient with End-Stage Renal Disease: A Case Report and Literature Review

“…In our case, there was an oversensing of only T waves. Oranus et al reported a case of TWOS due to a change in the electrical vector following T wave remodeling and progression of the hypertrophic obstructive cardiomyopathy (HOCM) scar, causing loss of R waves in a 19-year-old male with a history of HOCM and Wolff-Parkinson-White (WPW) syndrome [ 12 ]. A similar case of cardiac remodeling leading to uncorrectable T wave oversensing was reported by Saleem et al [ 13 ].…”