Noise caused by involuntary muscle response may inhibit detection of ventricular fibrillation during defibrillation testing

Baalman, Sarah W.E.; Kooiman, Kirsten M.; Quast, Anne‐Floor B.E.; Postema, Pieter G.; Donnelley, Steven; Knops, Reinoud E.

doi:10.1016/j.hrcr.2019.11.004

Cited by 3 publications

(2 citation statements)

References 5 publications

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“… 2 Previous case report also described that noise caused by involuntary muscle response may inhibit detection of VF during DFT. 9 In our case, shock was not delivered owing to a sustained diagnosis of noise on the electrogram in the primary vector proximal to the diaphragm after a 50-Hz burst, which persisted in the primary vector after sinus rhythm restoration by an external shock. Subcutaneous implantable cardioverter–defibrillator could deliver an appropriate shock after changing to the secondary vector, which was further from the diaphragm, although noise was observed in the alternate vector proximal to the diaphragm after sinus rhythm restoration.…”

Section: Discussionmentioning

confidence: 75%

Absence of shock therapy related to improper sensing of noise on the defibrillation test during subcutaneous implantable cardioverter–defibrillator implantation: a case report

Tamura

Yoshiyama

Doi

et al. 2020

European Heart Journal - Case Reports

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Background Subcutaneous implantable cardioverter–defibrillator (S-ICD) represents an efficient alternative to transvenous ICD in patients who do not require pacing. The intraoperative defibrillation test (DFT) is recommended during S-ICD implantation to confirm appropriate sensing and successful 65-J termination of induced ventricular fibrillation (VF). However, few cases of oversensing of noise inhibiting therapies have been reported. Case summary We report the case of a 50-year-old man who underwent S-ICD implantation for secondary prevention of sudden cardiac death. Immediately after S-ICD implantation, VF was induced using a 50-Hz burst; however, shock was not delivered owing to sustained noise on the electrogram in the primary vector. Therefore, an external rescue shock was needed at 150 J. We changed the sensing vector from primary to secondary and performed a second DFT. The S-ICD could deliver an appropriate shock and was able to successfully terminate VF without noise markers in the secondary vector. During the second DFT, one back-up pacing was delivered after the shock; the sensing vector then automatically switched from the secondary to the alternate vector. However, noise was observed in the alternate vector despite sinus rhythm restoration. Discussion The present case demonstrated that noise was recorded in two different vectors during DFT, possibly supporting the hypothesis that the muscle spasm of the diaphragm induced by the 50-Hz burst causes oversensing of noise by the S-ICD.

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Section: Discussionmentioning

confidence: 75%

Absence of shock therapy related to improper sensing of noise on the defibrillation test during subcutaneous implantable cardioverter–defibrillator implantation: a case report

Tamura

Yoshiyama

Doi

et al. 2020

European Heart Journal - Case Reports

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“…A retrospective comparison between S-ICD with and without DFT during implant showed no effect on first shock efficacy of the device [26] and a third analysis reported successful defibrillation of all spontaneous ventricular arrhythmias (n = 6) after no DFT was performed during implant [27]. On the other hand, one study reported sustained noise oversensing during induced VF in 4% of S-ICD patients, which resulted in delay of therapy, [28] although this could be the result of oversensing of myopotentials by the diaphragmatic muscles caused by the induction of VF [29]. Another single centre study showed that the first shock during DFT was successful in just 75% and argues that DFT is still necessary for S-ICD implants [30].…”

Section: Omission Of Dft In S-icd Implantsmentioning

confidence: 99%

Defibrillation testing during implantation of the subcutaneous implantable cardioverter-defibrillator: a necessary standard or becoming redundant?

2020

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Since the publication of the SIMPLE and NORDIC trials, defibrillation testing (DFT) is rarely performed during routine implantation of transvenous implantable cardioverter-defibrillators (ICD). However, the results of these trials cannot be extrapolated to the later introduced subcutaneous ICD (S-ICD) and a class I recommendation to perform DFT during the implantation of these devices remains in the current guidelines. Due to the high conversion success rate of DFT on one hand, and the risk of complications on the other, a significant number of physicians omit DFT in S-ICD recipients. Several retrospective analyses have assessed the safety of the omission of DFT and report contradicting results and recommendations. It is known that implant position, as well as device factors and patient characteristics, influence defibrillation success. A better comprehension of these factors and their relationship could lead to more reliable and safer alternatives to DFT. An ongoing randomised clinical trial, which is expected to end in 2023, is the first study to implement a method that assesses implant position to identify patients who are likely to fail their DFT.

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S-ICDs: advantages and opportunities for improvement

Friedli

Burri

2022

Expert Review of Medical Devices

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Noise caused by involuntary muscle response may inhibit detection of ventricular fibrillation during defibrillation testing

Cited by 3 publications

References 5 publications

Absence of shock therapy related to improper sensing of noise on the defibrillation test during subcutaneous implantable cardioverter–defibrillator implantation: a case report

Absence of shock therapy related to improper sensing of noise on the defibrillation test during subcutaneous implantable cardioverter–defibrillator implantation: a case report

Defibrillation testing during implantation of the subcutaneous implantable cardioverter-defibrillator: a necessary standard or becoming redundant?

S-ICDs: advantages and opportunities for improvement

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