Key result
High-amplitude atrial leadless pacing triggers S-ICD oversensing that resolves with reduced pacing amplitude.
Why the study?
S-ICDs and leadless pacemakers are increasingly used together, but data on their combined use are limited.
Does an atrial leadless pacemaker cause sensing interference with an S-ICD?
Case Report (n=1)
Does an atrial leadless pacemaker cause sensing interference with an S-ICD?
This case demonstrates that atrial leadless pacemakers can cause sensing interference with S-ICDs, which can be resolved by adjusting the pacing amplitude.
Supports feasibility of combined S-ICD and atrial LP after infection; leaves open need for prospective data before wider use.
BACKGROUND: Subcutaneous implantable cardioverter-defibrillators (S-ICDs) and leadless pacemakers (LPs) are increasingly used together, although data on combined use are limited. CASE SUMMARY: A 79-year-old man with ischemic cardiomyopathy and 2 prior episodes of bacteremia requiring transvenous implantable cardioverter-defibrillator lead extraction received an S-ICD. He later developed tachycardia-bradycardia syndrome. Given his prior lead infections, an atrial LP was placed. Testing during implantation revealed high pacing thresholds. Therefore, the LP was programmed to 6 V at 0.4 ms. Remote monitoring noted S-ICD oversensing of the atrial pacing spike. Reduction of his LP amplitude to 1.5 V at 0.4 ms resolved the oversensing. DISCUSSION: The use of S-ICD and ventricular LP is well described and occasionally not feasible due to sensing interference. The use of an atrial LP with an S-ICD is uncommon, and sensing interference is unlikely. This case shows atrial LP interference with S-ICD sensing and highlights possible solutions.
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Ossi et al. (2026) conducted a case report in Ischemic cardiomyopathy and tachycardia-bradycardia syndrome (n=1). Atrial leadless pacemaker and S-ICD was evaluated on S-ICD oversensing of atrial pacing spike. Programming an atrial leadless pacemaker to a high amplitude (6 V) caused S-ICD oversensing, which was successfully resolved by reducing the pacing amplitude to 1.5 V.
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