Related Experiment Video

Updated: Aug 17, 2025

A New Single Chamber Implantable Defibrillator with Atrial Sensing: A Practical Demonstration of Sensing and Ease of Implantation
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A New Single Chamber Implantable Defibrillator with Atrial Sensing: A Practical Demonstration of Sensing and Ease of Implantation

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Hyperkalemia Causing Inappropriate Subcutaneous Implantable Cardioverter Defibrillator Shocks in a Patient with

Bachar Botrus1, Arun U Mahtani1, Ryan Isber2

  • 1Internal Medicine, Richmond University Medical Center, New York, USA.

Cureus
|December 12, 2022
PubMed

Insights

Subcutaneous implantable cardioverter-defibrillators (S-ICDs) can cause inappropriate shocks in end-stage renal disease (ESRD) patients due to hyperkalemia-induced T wave oversensing. This case highlights a critical S-ICD management challenge in ESRD patients.

Area of Science:

  • Cardiology
  • Nephrology
  • Biomedical Engineering

Background:

  • Subcutaneous implantable cardioverter-defibrillators (S-ICDs) offer an alternative to transvenous systems, with lower infection rates but higher inappropriate shock risks.
  • End-stage renal disease (ESRD) patients frequently experience electrolyte imbalances, notably hyperkalemia, which can alter cardiac electrical activity.

Observation:

  • A patient with ESRD undergoing hemodialysis experienced recurrent inappropriate shocks from their S-ICD during sinus rhythm.
  • Electrocardiogram analysis revealed T wave oversensing attributed to hyperkalemia-induced changes in T wave morphology.

Findings:

  • Hyperkalemia in ESRD patients can lead to significant T wave amplitude increases, mimicking ventricular arrhythmias and causing S-ICD oversensing.
  • This phenomenon resulted in unnecessary and potentially harmful electrical therapies delivered by the S-ICD.

Implications:

  • Clinicians must consider electrolyte disturbances, particularly hyperkalemia, when managing S-ICD patients with ESRD.
  • S-ICD programming and monitoring strategies may need adjustment in ESRD patients to mitigate hyperkalemia-related oversensing events.

Keywords:
chronic renal insufficiencydefibrillator shockdefibrillatorselectrodesend stage renal disease (esrd)hyperkalemiaimplantable-cardioverter defibrillatorshocksubcutaneous implantable cardioverter

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