Transient Early T Wave Sensing by Implanted Programmable Demand Pulse Generator

Abstract

A seven-year-old girl with a permanent epicardial programmable pulse generator developed inappropriate slowing of the pacing rate due to oversensing a combination of T wave and afterpotential voltage. This phenomenon occurred only in the first three days after implantation and was demonstrable only at long programmed pulse widths. Our observations suggest that the current of injury in the early post-operative period may generate a relatively high T wave voltage capable of combining with a large afterpotential to produce a signal exceeding the sensitivity of a demand pulse generator.

Shock‐Induced Ventricular Tachycardia: What Is the Mechanism?

“…However, the degree of alternation may be very small, as seen in this case (RR interval alternation of only 10 ms). Furthermore, the occurrence of T‐wave oversensing is often intermittent . In the case presented, T‐wave oversensing was intermittently present in the first part of the RR plot (Fig.…”

Resolution of T‐Wave Oversensing with Implantable Cardioverter Defibrillator Generator Replacement in an Adolescent

“…Besides long QT syndrome, congenital short QT syndrome, cardiomyopathies, and Brugada syndrome are associated with higher risk for T‐wave oversensing‐related inappropriate ICD discharges 8–11 . T‐wave oversensing can also occur secondary to temporary increase in T‐wave voltage as a result of electrolyte imbalances, ischemia, trauma, and current of injury following lead implantation 12,13 …”

Inappropriate Pacing Inhibition Triggered by QT Prolongation due to T Wave Oversensing in an ICD Recipient Presenting with Long QT Syndrome

“…In recipients of implantable cardioverter defibrillator (ICD), T wave oversensing (TWOS) can cause the following events: 1) inappropriate shock delivery during spontaneous rhythm because the tachycardia interval criterion is fulfilled (1-3), and 2) inappropriate inhibition of pacing during bradycardia (4). Augmentation of the intracardiac T wave amplitude, attenuation of the intracardiac R wave voltage, or both, are common causes of TWOS (5).…”