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Updated: Mar 25, 2026

A New Single Chamber Implantable Defibrillator with Atrial Sensing: A Practical Demonstration of Sensing and Ease of Implantation
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Inappropriate Implantable Cardioverter-Defibrillator Shock from QRS Double Counting in the Setting of Hyperkalemia

Akash Dadlani1, Jonathan W Dukes1, Nitish Badhwar1

  • 1Division of Electrophysiology, Department of Medicine, University of California, San Francisco, 500 Parnassus Avenue, San Francisco, CA 94143, USA.

Cardiac Electrophysiology Clinics
|February 28, 2016
PubMed

Insights

Managing arrhythmias in patients with implantable cardioverter-defibrillators (ICDs) during hyperkalemia requires careful consideration. Temporarily suspending ICD therapies during critical electrolyte correction can prevent inappropriate shocks.

Area of Science:

  • Cardiology
  • Electrophysiology
  • Critical Care Medicine

Background:

  • Arrhythmia management in patients with implantable cardioverter-defibrillators (ICDs) presents unique challenges.
  • Hyperkalemia, a severe electrolyte imbalance, can significantly affect cardiac function and device performance.

Observation:

  • This case highlights the complexity of managing patients with ICDs experiencing hyperkalemia.
  • Extreme electrolyte derangements can lead to inappropriate ICD shocks.

Findings:

  • Temporary suspension of ICD therapies is crucial during intensive care treatment for severe hyperkalemia.
  • Close patient monitoring is essential until electrocardiogram normalization.

Implications:

  • This approach helps prevent potentially harmful inappropriate shocks in critical care settings.
  • Guidelines for ICD management during electrolyte disturbances need to consider temporary therapy suspension and careful reactivation protocols.

Keywords:
HyperkalemiaICDInappropriate shock

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