Key result
LV lead disconnection stops inappropriate biventricular ICD shocks caused by double counting.
Why the study?
Inappropriate shocks due to double counting of ventricular sensed events in biventricular ICDs present a clinical management challenge.
Case Report (n=1)
Disconnecting the left ventricular lead in a biventricular ICD can resolve inappropriate shocks caused by double counting of ventricular sensed events.
May cause early inappropriate shocks from LV/RV double counting after biventricular ICD; leaves open optimal programming approaches.
A 53-year-old man with nonischemic cardiomyopathy underwent implantation of a biventricular implantable cardioverter defibrillator (ICD) for symptomatic ventricular tachycardia. He received five shocks while attempting to exercise, 48 hours after implantation. Interrogation of the device revealed double counting of ventricular sensed events by the left and right ventricular leads. Shortening the AV delay and AV nodal blockade (beta-blocker) to promote ventricular pacing failed to prevent additional inappropriate ICD discharges. After detailed consideration of all options including AV nodal ablation, we chose to disconnect the left ventricular lead pending availability of newer devices with sensing functions limited to the right ventricular lead. Since then, the patient has not experienced any additional inappropriate discharges.
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Srivathsan et al. (2003) conducted a case report in Nonischemic cardiomyopathy with symptomatic ventricular tachycardia (n=1). Disconnection of the left ventricular lead was evaluated on Inappropriate ICD shocks. Disconnecting the left ventricular lead of a biventricular ICD successfully prevented further inappropriate shocks caused by double counting of ventricular sensed events.
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