Lead Interaction: Rare Cause of Oversensing During Implantation Procedure of Implantable Cardioverter‐Defibrillator System

Gardas, Rafał; Młynarski, Rafal; Staszak, Katarzyna; Drzewiecka, Anna; Piłat, Eugeniusz; Zajac, T; Kargul, Włodzimierz

doi:10.1111/j.1540-8159.2006.00510.x

Cited by 10 publications

(5 citation statements)

References 5 publications

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“…However, spike potentials on the T wave were observed before the fracture of the implantable cardioverter-defibrillator lead.During the upgrade implantation, the operator has to confirm that the defibrillation lead is not in contact with the remaining lead in multiple views to avoid friction between leads.Interaction between 2 leads in the right ventricle was reported to cause oversensing of electrical signals and inappropriate shocks in patients with an implantable cardioverter-defibrillator (ICD) 1, 2. This case report describes unusual lead fractures after addition of a defibrillation lead.…”

Section: Introductionmentioning

confidence: 99%

Unusual fracture in a Durata lead with shock coil fragmentation and cable externalization

Sato

Soejima

Yoshino

et al. 2017

HeartRhythm Case Reports

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Section: Introductionmentioning

confidence: 99%

Unusual fracture in a Durata lead with shock coil fragmentation and cable externalization

Sato

Soejima

Yoshino

et al. 2017

HeartRhythm Case Reports

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“…Mechanical interaction between 2 endocardial leads [88][89][90] or a lead and a retained fragment 91 is a rare cause of oversensing that is usually suggested by the proximity of 2 leads on imaging. The few reports show substantial variation in signal morphology, mostly transient, intermediate-frequency signals.…”

Section: Lead-lead Interactionsmentioning

confidence: 99%

Troubleshooting Implanted Cardioverter Defibrillator Sensing Problems I

Swerdlow

Asirvatham

Ellenbogen

et al. 2014

Circ: Arrhythmia and Electrophysiology

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electrograms from floating bipolar atrial electrodes on defibrillation leads. 12,13 The former requires a dual-coil lead and the latter a specialized lead. Evaluating Sensing From ICD ElectrogramsFilter settings may influence electrogram appearance (Figure 2). Wideband signals with minimal filtering reproduce QRS complexes accurately and retain the distinctive, rounded appearance of T waves. Highly filtered narrowband signals display the signal that is compared with the sensing threshold in the sensing process, but they alter signal amplitude and polarity, markedly reducing the amplitude of signals with prominent low-frequency components, such as T waves and some components of VF ( Figure I in the Data Supplement). Programmable filter settings (St. Jude Medical and Biotronik) permit assessing the effect of filtering on R-and T-wave amplitude.Sampling is the process of converting an analog signal into a digital sequence. It must be performed at ≥2× the source's signal frequency to reproduce the source's information content completely. ICD telemetry reproduces cardiac signals completely because it samples at 128 to 256 Hz per channel, but it may distort nonphysiological signals periodically (Figure II in the Data Supplement) 14 and it may not completely reproduce myopotentials that have frequency content >100 Hz. Stored Versus Real-Time ElectrogramsStored electrograms and their corresponding interval and episode data are the primary sources for diagnosing devicedetected tachycardias. Real-time electrograms are useful in troubleshooting reproducible oversensing: lead or connector problems in the pocket may be identified by pocket manipulation, pectoral or diaphragmatic myopotentials can be provoked by pectoral muscle contraction and straining or deep breathing, respectively (Figure III in the Data Supplement). Differential electrograms recorded simultaneously between 1 common electrode and 2 different electrodes are useful when lead or connector-related oversensing is suspected (Figure 3). Role of Additional Diagnostics, Alerts, and Remote MonitoringTrend plots of P-and R-wave amplitude, impedance measurements and trends, and algorithms that identify oversensing facilitate electrogram interpretation as discussed below. Alerts for suspected oversensing may notify the patient using audible tones or pulse generator vibration, may be transmitted via internet-based remote-monitoring networks, or both. Remote monitoring has transformed follow-up of sensing problems, permitting rapid determination of cause of an alert and implementation of a response plan, especially for devices with wireless telemetry.16,17 Troubleshooting Ventricular OversensingPresentation, Classification, and Recognition Clinical PresentationIn ICD patients, ventricular oversensing of rapid signals presents as oversensing alerts or inappropriate detection of VT/ VF, often resulting in inappropriate shocks. In pacemakerdependent patients it also presents as failure to deliver bradycardia pacing. ClassificationOversensing can be classified by electro...

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“…The earlier observation that intracardiac mechanical interaction between leads can also manifest on the surface ECG may favor the first of the above explanations. Of note, a case of oversensing similar to the one we describe here has been reported earlier . Its underlying mechanism, however, was not analyzed.…”

Section: Commentarymentioning

confidence: 68%