Inappropriate cardioverter-defibrillator discharge continues to be a major problem in clinical practice.

Abstract

BACKGROUND:

The purpose of this study was to determine the rate and causes of inappropriate rhythm detection, and to compare adequacy of ventricular arrhythmia detection by single-chamber and dual-chamber cardioverter-defibrillators (ICD).

METHODS:

We evaluated 190 patients (age 57.2 +/- 11.2 years) with ICD.

FOLLOW-UP:

34.3 +/- +/- 22 months. Dual-chamber ICD was used in 54 patients.

RESULTS:

We evaluated 2244 arrhythmia events recognized as of ventricular origin, including ventricular tachycardia and ventricular fibrillation. 431 events (19.2%) were recognized erroneously and resulted in an inappropriate ICD discharge. Most cases of inappropriate therapies (182 events, 42.23%) were due to atrial fibrillation or flutter. Overall, inappropriate arrhythmia detection was found in 64 (33.6%) of 190 patients. In terms of the number of affected patients, the most common cause of inappropriate ICD discharge was sinus tachycardia - 23 (12.1%) patients, followed by atrial fibrillation - 16 (8.4%) patients. Among 54 patients with dual-chamber ICD, inappropriate therapy was noted in 21 (38.8%) patients, (T wave oversensing, sinus tachycardia and atrial fibrillation etc.). No significant difference was seen in the rate of inappropriate therapy due to a rapid supraventricular rhythm between patients with single-chamber versus dual-chamber ICD. In contrast, patients with single-chamber ICD more often experienced inappropriate therapy due to atrial fibrillation (155 vs. 28 patients) and sinus tachycardia (66 vs. 9 patients).

CONCLUSIONS:

Despite of introduction of new generations of ICDs, the problem of inappropriate ICD discharge could not be eliminated. The major problem is distinction between supraventricular arrhythmia and ventricular tachyarrhythmia.

• Authors: Łukasz Jodko, Zdzisława Kornacewicz-Jach, Jarosław Kaźmierczak, Ryszard Rzeuski, Joanna Zielonka, Robert Kaliszczak, Krzysztof Safranow
• Journal: Cardiology journal (Cardiol J) Vol. 16 Issue 5 Pg. 432-9 ( 2009) ISSN: 1898-018X [Electronic] Poland
• PMID: 19753522 (Publication Type: Comparative Study, Journal Article)

Topics

• Adolescent
• Adult
• Aged
• Atrial Fibrillation (diagnosis, physiopathology)
• Defibrillators, Implantable
• Diagnosis, Differential
• Diagnostic Errors
• Electric Countershock (adverse effects, instrumentation)
• Equipment Design
• Equipment Failure
• Female
• Humans
• Male
• Middle Aged
• Retrospective Studies
• Signal Processing, Computer-Assisted
• Tachycardia, Sinus (diagnosis, physiopathology)
• Tachycardia, Ventricular (diagnosis, physiopathology, therapy)
• Time Factors
• Treatment Outcome
• Ventricular Fibrillation (diagnosis, physiopathology, therapy)
• Young Adult