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Related Experiment Video

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A Research Method For Detecting Transient Myocardial Ischemia In Patients With Suspected Acute Coronary Syndrome Using Continuous ST-segment Analysis

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Lead Integrity Alert Triggered by T-wave Oversensing.

Asad A Aboud¹, Walter K Clair¹

¹Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.

The Journal of Innovations in Cardiac Rhythm Management

|May 6, 2020

Summary

T-wave oversensing (TWOS) in pacemakers can cause pauses and shocks. This case shows TWOS triggering a lead alert without actual lead failure, highlighting a diagnostic challenge.

Keywords:

T-wave oversensing implantable cardioverter-defibrillator lead integrity alert

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Area of Science:

Cardiology
Biomedical Engineering
Medical Device Technology

Background:

T-wave oversensing (TWOS) is a known issue in cardiac implantable electronic devices (CIEDs).
It can lead to inappropriate device therapies, including pauses and shocks.
Accurate differentiation between oversensing and lead malfunction is crucial for patient management.

Observation:

A case is presented involving TWOS in a patient with a pacemaker/defibrillator.
The oversensing event falsely triggered the Lead Integrity Alert system.
No actual lead failure or impedance abnormalities were detected.

Findings:

TWOS can mimic lead integrity issues, leading to false alerts.
The Lead Integrity Alert system may be sensitive to non-pathological electrograms.
This highlights the importance of comprehensive diagnostic evaluation beyond automated alerts.

Implications:

Clinicians must be aware that T-wave oversensing can trigger lead integrity alerts.
This necessitates careful interpretation of device alerts in the context of patient electrograms.
Improved algorithms may be needed to differentiate oversensing from true lead problems.