Biventricular implantable cardioverter defibrillator and inappropriate shocks

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.