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Unipolar defibrillator?

B B Pavri1, R T Ho, V Patel

  • 1Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia 19104, USA.

Pacing and Clinical Electrophysiology : PACE
|March 29, 2001
PubMed
Summary
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An implanted cardioverter-defibrillator (ICD) delivered an inappropriate shock due to unipolar pacing and myopotential oversensing. This case highlights potential issues with bipolar devices exhibiting unipolar behavior.

Area of Science:

  • Cardiology
  • Biomedical Engineering
  • Electrophysiology

Background:

  • Implantable cardioverter-defibrillators (ICDs) are crucial for managing life-threatening arrhythmias.
  • Bipolar lead systems are generally preferred for their improved signal-to-noise ratio and reduced oversensing risk.
  • Unipolar pacing and sensing configurations can be susceptible to electromagnetic interference and myopotential oversensing.

Observation:

  • A patient with an implanted defibrillator experienced an inappropriate shock.
  • The event was associated with unipolar pacing behavior despite the use of a bipolar device.
  • Myopotential oversensing was identified as a contributing factor to the inappropriate shock.

Findings:

  • The committed bipolar device exhibited unipolar pacing characteristics.

Related Experiment Videos

  • Oversensing of myopotentials led to the detection of a non-existent tachyarrhythmia.
  • This resulted in a life-saving but inappropriate shock delivery by the ICD.

    • Implications:

    • This case underscores the importance of recognizing and troubleshooting unipolar behavior in ostensibly bipolar ICD systems.
    • Understanding the mechanisms of myopotential oversensing is critical for preventing inappropriate shocks.
    • Further investigation into device behavior and lead integrity is warranted to optimize patient safety and therapeutic efficacy.