Key result
Single-chamber ICD detection criteria cause failed ventricular arrhythmia recognition across 50 clinical episodes.
Why the study?
There are anecdotal reports of sudden death despite a functional ICD programmed with single-chamber detection criteria, and scenarios leading to failed ventricular arrhythmia detection need clarification.
What scenarios lead to fatal or near-fatal outcomes due to inappropriately inhibited ICD therapy in devices programmed with single-chamber detection criteria?
Observational (n=24)
What scenarios lead to fatal or near-fatal outcomes due to inappropriately inhibited ICD therapy in devices programmed with single-chamber detection criteria?
High-rate programming and long detection times, especially when combined with rate stability and sudden onset criteria, can lead to failure of ventricular arrhythmia detection and withholding of life-saving ICD therapy.
Inappropriately inhibited ICD therapy may cause fatal events with single-chamber detection; leaves open optimal programming criteria.
BACKGROUND: There are anecdotal reports of sudden death despite a functional implantable cardioverter defibrillator (ICD). We sought to describe scenarios leading to fatal or near-fatal outcome due to inappropriately inhibited ICD therapy in devices programmed with single-chamber detection criteria. METHODS: Programmed settings, episode lists, and intracardiac electrograms from 24 patients with a life-threatening event (n = 12) or fatal outcome (n = 12) related to failed ventricular arrhythmia detection were used to clarify the underlying scenario. RESULTS: Fifty episodes of failed ventricular arrhythmia detection were identified and categorized into six scenarios: (1) spontaneous ventricular tachycardia (VT) or ventricular fibrillation (VF) with a rate below the detection limits, (2) misclassification of polymorphic VT (PVT) or VF as supraventricular tachycardia (SVT), (3) misclassification of VT/VF as cluster of nonsustained VT episodes, (4) misclassification of monomorphic VT (MVT) as SVT, (5) inappropriate shock abortion, and (6) false termination detection. These scenarios occurred respectively 6, 9, 3, 9, 8, and 15 times. In 9/9 (100%) patients with PVT/VF classified as SVT, rate stability was active for rates ranging from 222 to 250 beats/min. MVT detected as SVT was due to the sudden onset criterion in 7/9 (78%) patients and twice a consequence of the rate stability criterion active for rates ranging from 200 to 250 beats/min. CONCLUSION: We describe six scenarios leading to failure of ventricular arrhythmia detection in a single-chamber detection setting withholding life-saving therapy. These scenarios are more likely to occur with high-rate programming and long detection times, especially if combined with rate stability and sudden onset.
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Stroobandt et al. (2019) conducted an observational in Life-threatening event or fatal outcome due to failed ventricular arrhythmia detection in ICDs (n=24). Single-chamber detection criteria in ICDs was evaluated on Scenarios of failed ventricular arrhythmia detection. Single-chamber detection criteria in ICDs failed to detect ventricular arrhythmias in 50 episodes across 24 patients, often due to high-rate programming, rate stability, and sudden onset criteria.
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