Key result
CT-guided substernal S-ICD electrode relocation may resolve T-wave oversensing and suboptimal R/T ratios.
Why the study?
T-wave oversensing is the primary cause of SICD inappropriate shocks, prompting evaluation of relocation from a subcutaneous to a substernal position to manage suboptimal R/T ratios.
Does relocation of an SICD electrode from a subcutaneous to a substernal position prevent inappropriate shocks due to T-wave oversensing?
Case Report
Does relocation of an SICD electrode from a subcutaneous to a substernal position prevent inappropriate shocks due to T-wave oversensing?
Relocating an SICD electrode to a substernal position, guided by chest CT, can be an effective strategy to resolve inappropriate shocks caused by T-wave oversensing.
Answers are grounded in this paper and cite their sources.
Substernal SICD electrode relocation may mitigate T-wave oversensing; leaves open the need for prospective validation before wider use.
Key Teaching Points•The predominant contributor to subcutaneous implantable cardioverter-defibrillator (SICD) inappropriate shocks is T-wave oversensing.•A chest computed tomography (CT) scan is a useful tool to evaluate the amount of myocardium encompassed between the distal SICD electrode and generator. The CT scan can guide the approach to SICD revision in patients with suboptimal RT sensing.•In carefully selected patients, relocation of an SICD electrode from subcutaneous to substernal position may address the problem of suboptimal R/T ratios and T-wave oversensing. •The predominant contributor to subcutaneous implantable cardioverter-defibrillator (SICD) inappropriate shocks is T-wave oversensing.•A chest computed tomography (CT) scan is a useful tool to evaluate the amount of myocardium encompassed between the distal SICD electrode and generator. The CT scan can guide the approach to SICD revision in patients with suboptimal RT sensing.•In carefully selected patients, relocation of an SICD electrode from subcutaneous to substernal position may address the problem of suboptimal R/T ratios and T-wave oversensing.
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Do et al. (2019) conducted a case report in Inappropriate shocks from subcutaneous implantable cardioverter-defibrillator (SICD). Relocation of SICD electrode from subcutaneous to substernal position was evaluated. Relocation of a subcutaneous implantable cardioverter-defibrillator electrode to a substernal position, guided by chest CT, may address suboptimal R/T ratios and T-wave oversensing.
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