Inappropriate shock in a subcutaneous cardiac defibrillator due to residual air.
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SUBMITTER: Lee S
PROVIDER: S-EPMC5538068 | biostudies-other | 2017 Aug
REPOSITORIES: biostudies-other
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Project description:Background:Subcutaneous implantable cardioverter-defibrillators (S-ICDs) are increasingly used in patients at risk of fatal cardiac arrhythmias. Twiddler's syndrome is a condition in which a device is manipulated by the patient after implantation leading to lead twisting and retraction. Device manipulation has been reported multiple times in transvenous pacing systems and occasionally leads to inappropriate discharges from implanted defibrillators. However, little has been reported about device manipulation in S-ICD devices. Case summary:We present the case of a 16-year-old who underwent insertion of an S-ICD for idiopathic dilated cardiomyopathy. He represented for a pacing check following a discharge from the device. This showed a significant change in the sensed vectors. Chest radiographs confirmed lead retraction and suggested device manipulation. The device was turned off to prevent further inappropriate shocks. The patient underwent successful reimplantation of a S-ICD device. Discussion:This case highlights that twiddler's syndrome can occur in those with an S-ICD and lead to an inappropriate device discharge. The patient in this case had a number of risk factors that have been previously associated with twiddler's syndrome.
| S-EPMC7042151 | biostudies-literature
Project description:BackgroundImplantable cardioverter-defibrillator (ICD) is recommended for secondary prevention in patients with coronary spastic angina and aborted sudden cardiac death. The effectiveness of subcutaneous ICD (S-ICD) for patients with coronary artery spastic angina is controversial.Case summaryA 54-year-old man presented with ventricular fibrillation. Emergent coronary angiography showed diffuse narrowing of the coronary arteries that was reversible with isosorbide dinitrate. He was diagnosed with coronary spastic angina. S-ICD was implanted after the administration of a calcium-channel blocker and nicorandil. Seven months after the implantation, he collapsed again due to sinus node dysfunction and atrioventricular block caused by cardiac ischaemia. He developed cardiac arrest at both admissions. Six hours after the admission, electrocardiogram showed transient right bundle branch block. Inappropriate shocks were delivered because of low R-wave amplitude and T-wave oversense. S-ICD was replaced with a transvenous device in order to manage these two arrhythmias and inappropriate shocks.DiscussionPatients with coronary artery spasm and aborted sudden cardiac death are candidates for implantation of S-ICD, but there are risks of bradycardia and inappropriate shocks in other ischaemic events.
| S-EPMC7793180 | biostudies-literature
Project description: Not available
| S-EPMC9596353 | biostudies-literature
Project description:AimsIn subcutaneous implantable cardioverter defibrillator (S-ICD) recipients, the UNTOUCHED study demonstrated a very low inappropriate shock rate on programming a conditional zone between 200 and 250 bpm and a shock zone for arrhythmias >250 bpm. The extent to which this programming approach is adopted in clinical practice is still unknown, as is its impact on the rates of inappropriate and appropriate therapies.Methods and resultsWe assessed ICD programming on implantation and during follow-up in a cohort of 1468 consecutive S-ICD recipients in 56 Italian centres. We also measured the occurrence of inappropriate and appropriate shocks during follow-up. On implantation, the median programmed conditional zone cut-off was set to 200 bpm (IQR: 200-220) and the shock zone cut-off was 230 bpm (IQR: 210-250). During follow-up, the conditional zone cut-off rate was not significantly changed, while the shock zone cut-off was changed in 622 (42%) patients and the median value increased to 250 bpm (IQR: 230-250) (P < 0.001). UNTOUCHED-like programming of detection cut-offs was adopted in 426 (29%) patients immediately after device implantation, and in 714 (49%, P < 0.001) at the last follow-up. UNTOUCHED-like programming was independently associated with fewer inappropriate shocks (hazard ratio 0.50, 95%CI 0.25-0.98, P = 0.044), and had no impact on appropriate and ineffective shocks.ConclusionsIn recent years, S-ICD implanting centres have increasingly programmed high arrhythmia detection cut-off rates, at the time of implantation in the case of new S-ICD recipients, and during follow-up in the case of pre-existing implants. This has contributed significantly to reducing the incidence of inappropriate shocks in clinical practice. Rordorf: Programming of the S-ICD.Clinical trial registrationURL: http://clinicaltrials.gov/Identifier: NCT02275637.
| S-EPMC10227499 | biostudies-literature
Project description:ObjectivesTo characterize inappropriate shock delivery during pediatric in-hospital cardiac arrest (IHCA).DesignRetrospective cohort study.SettingAn international pediatric cardiac arrest quality improvement collaborative Pediatric Resuscitation Quality [pediRES-Q].PatientsAll IHCA events from 2015 to 2020 from the pediRES-Q Collaborative for which shock and electrocardiogram waveform data were available.InterventionsNone.Measurements and main resultsWe analyzed 418 shocks delivered during 159 cardiac arrest events, with 381 shocks during 158 events at 28 sites remaining after excluding undecipherable rhythms. We classified shocks as: 1) appropriate (ventricular fibrillation [VF] or wide complex ≥ 150/min); 2) indeterminate (narrow complex ≥ 150/min or wide complex 100-149/min); or 3) inappropriate (asystole, sinus, narrow complex < 150/min, or wide complex < 100/min) based on the rhythm immediately preceding shock delivery. Of delivered shocks, 57% were delivered appropriately for VF or wide complex rhythms with a rate greater than or equal to 150/min. Thirteen percent were classified as indeterminate. Thirty percent were delivered inappropriately for asystole (6.8%), sinus (3.1%), narrow complex less than 150/min (11%), or wide complex less than 100/min (8.9%) rhythms. Eighty-eight percent of all shocks were delivered in ICUs or emergency departments, and 30% of those were delivered inappropriately.ConclusionsThe rate of inappropriate shock delivery for pediatric IHCA in this international cohort is at least 30%, with 23% delivered to an organized electrical rhythm, identifying opportunity for improvement in rhythm identification training.
| S-EPMC10440232 | biostudies-literature
Project description:Abstract Background Subcutaneous implantable cardioverter-defibrillators (S-ICDs) are increasingly used in patients without a pacing indication, and may reduce venous complications, endocarditis and extraction morbidity. Subcutaneous implantable cardioverter-defibrillator displacements may be less obvious than their transvenous counterparts. Case summary A 59-year-old man was found to have dilated cardiomyopathy associated with heavy alcohol intake following investigation for a stroke. Despite 2 years of alcohol cessation and optimal drug therapy, his ejection fraction remained severely impaired, and he received an S-ICD using the manufacturer recommended screening and implant method, and by an experienced operator. Ten months later, inappropriate shocks were delivered despite optimal programming. Device displacement was demonstrated by lateral chest radiography on the second instance of inappropriate therapy. On the first admission, a lateral film was not performed, and simple device programming was undertaken which failed to prevent the second occurrence. The patient requested an explant; as ventricular function had improved following initiation of sacubutril/valsartan, the clinical team opted to remove the device. Discussion Careful inspection of lateral chest films and review of device indication are needed to reduce the risk of inappropriate shocks. This is the first description of inappropriate device activity following lone generator displacement—lead displacement is well described.
| S-EPMC9901276 | biostudies-literature
Project description:The genus Cupriavidus consists of Gram-negative, nonfermenting bacteria most of which are environmental organisms, though some species have been associated with human disease. We report the recovery and identification of an isolate that represents a previously undescribed species of Cupriavidus from an implantable cardiac defibrillator pocket infection.
| S-EPMC2897534 | biostudies-literature
Project description:Background and objectivesPreimplantation QRS-T morphology screening (TMS) is a composite tool for selecting subcutaneous implantable cardioverter defibrillator (S-ICD) candidates. However, its role in predicting the patient's response to cardiac resynchronization therapy (CRT) is uncertain.MethodsA total of 55 consecutive de novo CRT candidates were enrolled between January 2016 and March 2017. Electrocardiogram (ECG) and TMS were performed before and soon after implantation. The ECG parameters were recorded, including QRS duration and morphology (such as ΔQRS_Index, QTc during biventricular pacing mode [BiV pacing QTc], and QRS/T ratio during biventricular pacing mode [BiV pacing QRS/T ratio]). TMS monitored three sensory vectors of the S-ICD. Six months after implantation, the responses to CRT were evaluated.ResultsThirty-nine patients (70.9%) passed the TMS during biventricular pacing mode. At the six-month follow-up, the number of responders and super-responders was significantly higher in the passing group than in the non-passing group (responders: 31/39 [79.5%] vs. 5/16 [31.3%], p<0.001; super-responders: 9/39 [23.1%] vs. 1/16 [6.3%], p=0.020). The super-response rate was higher among patients who passed all three vectors than among those who passed 1 or 2 vectors (3 vs. 2 vectors, p=0.018; 3 vs. 1 vector, p=0.003). A smaller left atrial diameter, vectors that passed TMS during biventricular pacing mode, and larger ΔQRS_Index values were independently associated with good CRT response.ConclusionsOur study demonstrated that patients on CRT who pass the TMS during biventricular pacing mode are more likely to respond and super-respond to CRT.
| S-EPMC7707981 | biostudies-literature
Project description:AimsAir entrapment (AE) has been reported as a potential cause of early inappropriate shocks (ISs) following subcutaneous implantable cardioverter defibrillator (S-ICD) implantation, but a cause-effect relationship is not always evident. This systematic review aims to analyse this phenomenon concerning implantation techniques, electrogram (EGM) features, radiologic findings, and patient management.Methods and resultsA systematic search was conducted using PubMed, Embase, and Google Scholar databases following the PRISMA guidelines to obtain all available literature data since 2010 on S-ICD malfunctions possibly due to AE. The final analysis included 54 patients with AE as a potential cause of S-ICD malfunction. Overall, the aggregate incidence of this condition was 1.2%. Of ICD malfunctions possibly due to AE, 93% were ISs, and 95% were recorded within the first week following implantation. Radiologic diagnosis of AE was confirmed in 28% of the entire study cohort and in 68% of patients in whom this diagnostic examination was reported. At the time of device malfunction, EGMs showed artefacts, baseline drift, and QRS voltage reduction in 95, 76, and 67% of episodes, respectively. Management included ICD reprogramming or testing, no action (observation), and invasive implant revision in 57, 33, and 10% of patients, respectively. No recurrences occurred during follow-up, irrespective of management performed.ConclusionsDevice malfunction possibly due to AE may occur in ∼1% of S-ICD recipients. Diagnosis is strongly suggested by early occurrence, characteristic EGM features, and radiologic findings. Non-invasive management, principally device reprogramming, appears to be effective in most patients.
| S-EPMC9757921 | biostudies-literature
Project description:The subcutaneous implantable cardioverter-defibrillator (S-ICD) has recently been approved for commercial use in Europe, New Zealand and the United States. It is comprised of a pulse generator, placed subcutaneously in a left lateral position, and a parasternal subcutaneous lead-electrode with two sensing electrodes separated by a shocking coil. Being an entirely subcutaneous system it avoids important periprocedural and long-term complications associated with transvenous implantable cardioverter-defibrillator (TV-ICD) systems as well as the need for fluoroscopy during implant surgery. Suitable candidates include pediatric patients with congenital heart disease that limits intracavitary lead placements, those with obstructed venous access, chronic indwelling catheters or high infection risk, as well as young patients with electrical heart disease (e.g., Brugada Syndrome, long QT syndrome, and hypertrophic cardiomyopathy). Nevertheless, given the absence of intracavitary leads, the S-ICD is unable to offer pacing (apart from short-term post-shock pacing). It is therefore not suitable in patients with an indication for antibradycardia pacing or cardiac resynchronization therapy, or with a history of repetitive monomorphic ventricular tachycardia that would benefit from antitachycardia pacing. Current data from initial clinical studies and post-commercialization "real-life" case series, including over 700 patients, have so far been promising and shown that the S-ICD successfully converts induced and spontaneous ventricular tachycardia/ventricular fibrillation episodes with associated complication and inappropriate shock rates similar to that of TV-ICDs. Furthermore, by using far-field electrograms better tachyarrhythmia discrimination when compared to TV-ICDs has been reported. Future results from ongoing clinical studies will determine the S-ICD system's long-term performance, and better define suitable patient profiles.
| S-EPMC3783987 | biostudies-literature