Key result
A systematic approach to identifying the cause of extraneous noise on ICD electrograms can distinguish myopotential oversensing from lead failure, guiding appropriate treatment.
Case Report (n=2)
A systematic approach to diagnosing noise on ICD electrograms is essential to differentiate between lead failure and myopotential oversensing, thereby preventing inappropriate shocks and guiding appropriate management.
May avoid unnecessary lead revisions in ICD patients with noise; hypothesis-generating case report requiring prospective validation.
The appearance of noise on electrograms (EGMs) recorded from the lead of an implantable cardioverter-defibrillator (ICD) may be owing to oversensing of myopotentials, insulation breach, conductor coil fracture, loose set screw, or electromagnetic interference from an external source. The extraneous noise may lead to inappropriate shocks or inhibition of pacing. We describe two cases of pectoral myopotentials oversensing in patients with ICD and an approach to distinguish among the various extraneous noises recorded on EGMs. A systematic approach to identify the cause of the noise is important to render an appropriate treatment, which might include simple device re-programming or require re-operation and lead revision or replacement.
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Kowalski et al. (2008) conducted a case report in Pectoral myopotentials oversensing in patients with ICD (n=2). Systematic approach to identify the cause of noise on electrograms was evaluated. A systematic approach to identifying the cause of extraneous noise on ICD electrograms can distinguish myopotential oversensing from lead failure, guiding appropriate treatment.
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