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. 2022 Oct;19(10):1704-1711.
doi: 10.1016/j.hrthm.2022.05.037. Epub 2022 Jun 7.

Clinical impact of ECG changes on oversensing of subcutaneous implantable cardioverter-defibrillators

Takahiro Hakamata  1 , Sou Otsuki  2 , Daisuke Izumi  1 , Yuta Sakaguchi  1 , Naomasa Suzuki  1 , Yasuhiro Ikami  1 , Yuki Hasegawa  1 , Nobue Yagihara  1 , Kenichi Iijima  1 , Masaomi Chinushi  1 , Koichi Fuse  3 , Takayuki Inomata  1
Affiliations

Clinical impact of ECG changes on oversensing of subcutaneous implantable cardioverter-defibrillators

Takahiro Hakamata et al. Heart Rhythm. 2022 Oct.

Abstract

Background: Inappropriate shocks delivered by subcutaneous implantable cardioverter-defibrillators (S-ICDs) are most frequently caused by cardiac oversensing. However, the predictors for oversensing of S-ICD remain unclear.

Objective: We aimed to investigate the predictors for oversensing of S-ICD, especially clinical impact of an electrocardiographic (ECG) change.

Methods: We retrospectively enrolled 99 consecutive patients who underwent S-ICD implantation between 2013 and 2021. Oversensing events were defined as inappropriate charge of the capacitors induced by cardiac or noncardiac signals other than tachycardia.

Results: During a median follow-up period of 34 months (interquartile range 20-50 months), 11 of 99 patients (11%) experienced 34 oversensing events and 4 patients (4%) received inappropriate shocks during their events. Six patients exhibited ECG changes (bundle branch block, 3; ventricular pacing, 1; inverted T wave, 1; poor R-wave progression, 1) during the follow-up period. Oversensing events were observed in 4 of 6 patients with ECG change (67%), and 3 patients underwent S-ICD removal because of inevitable shock. Contrastingly, of the remaining patients without ECG change, all 7 patients who experienced oversensing events could continue using S-ICD with the reprogramming sensing vector and/or restriction of excessive exercise. Logistic regression analysis showed that lower voltage of Sokolow-Lyon ECG (V1S + V5R) was the predictor of oversensing in patients without ECG change. When the cutoff value was 2.1 mV, the sensitivity, specificity, positive predictive value, and negative predictive value were 85.7%, 62.7%, 15.7%, and 98.1%, respectively.

Conclusion: Unavoidable oversensing resulting in S-ICD removal is caused by ECG change. Oversensing in patients without ECG change can be managed.

Keywords: ECG change; Inappropriate shocks (IASs); Oversensing; Subcutaneous implantable cardioverter-defibrillator (S-ICD).

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