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Anil H Punjabi1, Arlene Dermovsesian2, Ankur A Karnik2

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|July 13, 2018
PubMed
Summary

T wave oversensing (TWOS) in implantable cardioverter defibrillators (ICDs) can cause pacing inhibition. This case highlights how ICD sensitivity algorithms, not just lead configurations, can resolve TWOS.

Keywords:
Dedicated bipolarICDInhibition of pacingIntegrated bipolarSensitivityT wave oversensing

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Area of Science:

  • Cardiology
  • Biomedical Engineering
  • Medical Devices

Background:

  • Modern implantable cardioverter defibrillators (ICDs) utilize sophisticated sensing algorithms to differentiate between life-threatening arrhythmias and normal cardiac activity.
  • T wave oversensing (TWOS) is a known issue that can lead to inappropriate device behavior, such as pacing inhibition, without causing harmful shocks.

Observation:

  • A patient with a Medtronic ICD experienced TWOS, resulting in pacing inhibition despite using both true bipolar (TB) and integrated bipolar (IB) sensing configurations.
  • Standard troubleshooting methods like lead revision or programming the ICD to a less sensitive setting were considered but deemed suboptimal.

Findings:

  • Replacing the Medtronic ICD with a Boston Scientific ICD successfully resolved the TWOS issue and restored appropriate device function.
  • This case suggests that the specific sensing algorithm employed by the ICD manufacturer plays a critical role in managing TWOS.

Implications:

  • ICD selection may be influenced by the device's underlying sensing algorithm sensitivity, particularly in patients prone to TWOS.
  • Further research into comparative analysis of ICD sensing algorithms across different manufacturers is warranted to optimize patient care.
  • This finding offers an alternative management strategy for TWOS beyond lead manipulation or reduced device sensitivity.