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Parasystole in a mahaim accessory pathway

Roopa Tekkatte1, Ahmed Hamoud2, Claire Warren2

  • 1Cardiff and Vale University Health Board, United Kingdom.

Indian Pacing and Electrophysiology Journal
|July 25, 2014
PubMed

Insights

Subcutaneous implantable cardioverter-defibrillators (S-ICDs) offer an alternative for hypertrophic cardiomyopathy (HCM) patients at high risk of sudden cardiac death. However, this case highlights potential challenges with S-ICD lead placement and sensing in HCM.

Area of Science:

  • Cardiology
  • Electrophysiology
  • Medical Devices

Background:

  • Hypertrophic cardiomyopathy (HCM) is a significant risk factor for sudden cardiac death (SCD).
  • Implantable Cardioverter-Defibrillators (ICDs) are used for primary and secondary prevention of SCD in HCM.
  • Subcutaneous ICDs (S-ICDs) provide a leadless alternative to transvenous ICDs.

Purpose of the Study:

  • To report the use of S-ICD in a patient with HCM and multiple SCD risk factors.
  • To describe complications encountered with S-ICD therapy in this specific patient population.

Main Methods:

  • Case report detailing the implantation and subsequent management of an S-ICD in a patient with HCM.
  • Analysis of device performance, including sensing parameters and shock delivery.

Main Results:

  • The S-ICD required extraction due to recurrent inappropriate shocks.
  • Inappropriate shocks were attributed to oversensing of atrial flutter.
  • The S-ICD failed to treat a ventricular tachycardia (VT) episode.

Conclusions:

  • This case highlights a potential limitation of S-ICD therapy in HCM patients related to oversensing.
  • Atrial flutter oversensing causing inappropriate shocks with S-ICD has not been previously reported.
  • Further investigation into S-ICD sensing characteristics in HCM patients is warranted.

Keywords:
Atrial FlutterInappropriate TherapiesSubcutaneous ICD

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