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Case Reports
. 2025 Aug 30;11(11):1236-1239.
doi: 10.1016/j.hrcr.2025.08.032. eCollection 2025 Nov.

When leads are not an option: Optimizing subcutaneous implantable cardioverter-defibrillator and leadless pacemaker interaction

Lucía Canales Muñoz  1 , Paula Sánchez-Somonte  1 , Sergio Castrejon-Castrejon  1 , Marcel Martínez-Cossiani  1 , Omar Al Razzo  2 , Jose Luis Merino  1
Affiliations
Case Reports

When leads are not an option: Optimizing subcutaneous implantable cardioverter-defibrillator and leadless pacemaker interaction

Lucía Canales Muñoz et al. HeartRhythm Case Rep. .
No abstract available

Keywords: Inappropriate shock; Leadless pacemaker; SMART Pass filter; Subcutaneous defibrillator; T-wave oversensing.

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Conflict of interest statement

The authors have no conflicts of interest to disclose.

Figures

Figure 1
Figure 1
Venography showing stenosis of the left subclavian and innominate veins, as well as thrombosis at the origin of the superior vena cava with significant collateral development at the cervical level.
Figure 2
Figure 2
Chest radiograph in anteroposterior projection with a leadless pacemaker and a subcutaneous implantable cardioverter-defibrillator. The 2 QRS detection vectors used in the patient are shown.
Figure 3
Figure 3
Electrocardiogram with native rhythm (A) and paced rhythm from a leadless pacemaker (B) with proper sensing by a subcutaneous implantable cardioverter-defibrillator. S = sensing.
Figure 4
Figure 4
Electrocardiogram recording from a subcutaneous implantable cardioverter-defibrillator in sinus bradycardia. Native rhythm alternating with paced rhythm from the pacemaker. Intermittent T-wave oversensing is observed after the deactivation of the SMART Pass algorithm owing to sinus bradycardia. S = sensing.
Figure 5
Figure 5
Electrocardiogram trace from the subcutaneous implantable cardioverter-defibrillator during the inappropriate discharge episode. It is showing sinus tachycardia with T-wave oversensing, identified within the device’s tachycardia zone, and ultimately delivering a shock. S = sensing; T = tachycardia.
See this image and copyright information in PMC

References

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    1. Tachibana M., Nishii N., Banba K., et al. SMART pass will prevent inappropriate operation of S-ICD. J Arrhythm. 2019;35:86–91. - PMC - PubMed
    1. Ishiwata M., Ueda N., Ishibashi K., et al. SMART Pass automatic deactivation of subcutaneous implantable cardioverter-defibrillators. Heart Rhythm. 2025;22:1255–1263. - PubMed

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