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Inappropriate disabling of an ICD noise-detection algorithm in pacemaker-dependent patients
Nicolas Welte1,2, Eli S Gang3, Charles D Swerdlow3
1Cardio-thoracic Unit, Bordeaux University Hospital (CHU), Pessac, France.
Pacing and Clinical Electrophysiology : PACE
|December 6, 2018
Summary
SecureSense algorithms in implantable cardioverter defibrillators can inappropriately deactivate. This may prevent withholding therapy for sustained oversensing in pacemaker-dependent patients.
Area of Science:
- Cardiology
- Biomedical Engineering
Background:
- SecureSense is an implantable cardioverter defibrillator (ICD) algorithm designed to distinguish lead noise from life-threatening arrhythmias like ventricular tachycardia/fibrillation.
- It achieves this by comparing near-field (NF) and far-field (FF) electrograms, withholding therapy if lead noise is detected.
Observation:
- The SecureSense algorithm automatically switches to a passive mode if it suspects undersensing on the FF channel to prevent inappropriate inhibition of therapy.
- This report details the first instances of SecureSense being inappropriately deactivated due to misdiagnosed FF undersensing.
Findings:
- In pacemaker-dependent patients, misdiagnosed FF undersensing led to the automatic deactivation of the SecureSense algorithm.
- This deactivation occurred despite the presence of sustained oversensing, which the algorithm should have managed.
Implications:
- Physicians must be aware of this potential failure mode in SecureSense, particularly in pacemaker-dependent individuals.
- The algorithm's inability to withhold therapy for sustained oversensing in these specific cases necessitates careful clinical consideration and monitoring.
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