Key result
Inappropriate ICD therapy due to atrial fibrillation resulted in proarrhythmic ventricular fibrillation and subsequent shocks caused by lead hyperpolarization oversensing in a 50-year-old man.
Case Report (n=1)
This case highlights the risk of inappropriate ICD shocks triggering proarrhythmia and lead hyperpolarization leading to further oversensing and shocks.
Alerts clinicians to proarrhythmic risks from inappropriate ICD shocks in AF; leaves open optimal sensing strategies to prevent cascades.
A 50-year-old man with an ischemic cardiomyopathy underwent ICD implantation for inducible ventricular fibrillation (VF). Sixteen months later he experienced inappropriate ICD therapy due to atrial fibrillation with a rapid ventricular response. The initial shock resulted in the initiation of VF (proarrhythmia) and the patient received an additional shock converting his rhythm to an idioventricular rhythm with a cycle length of 490 ms (122 beats/min). Due to lead hyperpolarization, the device oversensed ventricular events and the patient subsequently received additional shocks.
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HEALY et al. (2004) conducted a case report in Ischemic cardiomyopathy with inappropriate ICD therapy (n=1). ICD implantation was evaluated. Inappropriate ICD therapy due to atrial fibrillation resulted in proarrhythmic ventricular fibrillation and subsequent shocks caused by lead hyperpolarization oversensing in a 50-year-old man.
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