Invasive treatment for HOCM can cause intraventricular conduction delay and morphological ECG changes, increasing the risk of T-wave oversensing and inappropriate shocks in patients with S-ICDs.
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May warrant pre-procedural S-ICD sensing reassessment in HOCM; leaves open optimal device selection after septal ablation.
A 53-year-old female patient with hypertrophic obstructive cardiomyopathy (HOCM) was admitted for alcohol septal ablation (ASA). A subcutaneous internal cardioverter defibrillator (S-ICD) was implanted for primary prevention. After ASA, the patient developed a right bundle branch block, and the S-ICD delivered a total of five inappropriate shocks due to T-wave oversensing (TWOS). TWOS is a relatively frequent cause of inappropriate shocks in S-ICD patients. After invasive treatment for HOCM, there is a risk of developing intraventricular conduction delay and subsequent changes in QRS and T-wave morphology. This should be taken into consideration when ICD indication is evaluated in HOCM patients.
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Dijk et al. (2015) studied this question.
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