Key result
An inappropriate ICD shock was delivered following successful termination of ventricular tachycardia by antitachycardia pacing because the confirmation algorithm classified events during the charge period as arrhythmic.
Case Report (n=1)
No
This case highlights the necessity of understanding ICD programming algorithms to troubleshoot inappropriate shocks following successful antitachycardia pacing.
Alerts clinicians to confirmation algorithm pitfalls causing post-ATP shocks; leaves open broader incidence and mitigation strategies.
A 76-year-old female with a single chamber implantable cardioverter-defibrillator implanted for secondary prevention was referred due to multiple discharges. The device was programmed for ventricular tachycardia (VT) detection at 400 ms, fast VT detection at 280 ms, and ventricular fibrillation detection at 320 ms. Antitachycardia pacing (ATP) during charge was enabled. Interrogation revealed a VT episode with a mean cycle length of 270 ms, which was successfully terminated with ATP during charge. Seconds later, the device delivered a shock. This case illustrates the importance of understanding programming algorithms as part of troubleshooting when facing a scenario of device discharge.
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Nault et al. (2010) conducted a case report in Ischemic cardiomyopathy with ICD (n=1). Implantable cardioverter-defibrillator (ICD) was evaluated on Device discharge appropriateness. An inappropriate ICD shock was delivered following successful termination of ventricular tachycardia by antitachycardia pacing because the confirmation algorithm classified events during the charge period as arrhythmic.
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