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Incidence of myopotential induction in subcutaneous implantable cardioverter-defibrillator patients: Is the oversensing issue really solved?

      Background

      The subcutaneous implantable cardioverter-defibrillator (S-ICD) has established its role in the prevention of sudden cardiac death in a defined population. Inappropriate shocks and device malfunction in S-ICD therapy may be caused by myopotential (MP) oversensing.

      Objective

      The purpose of this study was to systematically evaluate a cohort of consecutive S-ICD patients for MP inducibility.

      Methods

      After S-ICD implantation, all vectors (primary [PrimV], secondary [SecV], alternative [AltV]) were analyzed during isometric chest press (ICP), lifting and holding a 20-kg weight, and side plank exercise (SPE), supporting the body weight on the left arm. When MPs were induced, signal classification was assessed: adequate noise detection, induced undersensing (R waves classified as noise), and oversensing (noise annotated as R waves). In case of noise induction in the current vector, device reprogramming to a noise-free vector was done.

      Results

      We systematically assessed 41 patients. In nearly all patients (90.2%), MPs were inducible. ICP was the most potent inductor of MPs. Whereas SecV (70.7%) and AltV (75.6%) were most vulnerable during ICP, PrimV was most affected during SPE (51.2%). In only a few cases did the S-ICD software distinguish correctly between MPs and QRS. MPs predominantly led to undersensing (up to 65.9%), but in up to 22% of patients MP-induced oversensing occurred but did not lead to tachycardia detection. No relation was seen between S-ICD lead and generator position and MP inducibility.

      Conclusion

      Induction of MPs during physical exercise was observed frequently. Although in most cases MP noise led to undersensing, oversensing events were commonly observed.

      Keywords

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      References

        • Priori S.G.
        • Blomström-Lundqvist C.
        • Mazzanti A.
        • et al.
        2015 ESC guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death.
        Eur Heart J. 2015; 36: 2793-2867
        • Al-khatib S.M.
        • Ackerman M.J.
        • Gillis A.M.
        • et al.
        2017 AHA/ACC/HRS guideline for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: executive summary.
        Heart Rhythm. 2018; 15: e190-e225
        • Kleemann T.
        • Becker T.
        • Doenges K.
        • et al.
        Annual rate of transvenous defibrillation lead defects in implantable cardioverter-defibrillators over a period of >10 years.
        Circulation. 2007; 115: 2474-2480
        • Borleffs C.J.W.
        • Van Erven L.
        • Van Bommel R.J.
        • et al.
        Risk of failure of transvenous implantable cardioverter-defibrillator leads.
        Circ Arrhythmia Electrophysiol. 2009; 2: 411-416
        • Lee D.S.
        • Krahn A.D.
        • Healey J.S.
        • et al.
        Evaluation of early complications related to de novo cardioverter defibrillator implantation. insights from the Ontario ICD database.
        J Am Coll Cardiol. 2010; 55: 774-782
        • Poole J.E.
        • Johnson G.W.
        • Hellkamp A.S.
        • et al.
        Prognostic importance of defibrillator shocks in patients with heart failure.
        N Engl J Med. 2008; 359: 1009-1017
        • Bardy G.H.
        • Smith W.M.
        • Hood M.A.
        • et al.
        An entirely subcutaneous implantable cardioverter–defibrillator.
        N Engl J Med. 2010; 363: 36-44
        • Lambiase P.D.
        • Barr C.
        • Theuns D.A.M.J.
        • et al.
        Worldwide experience with a totally subcutaneous implantable defibrillator: early results from the EFFORTLESS S-ICD registry.
        Eur Heart J. 2014; 35: 1657-1665
        • Weiss R.
        • Knight B.P.
        • Gold M.R.
        • et al.
        Safety and efficacy of a totally subcutaneous implantable-cardioverter defibrillator.
        Circulation. 2013; 128: 944-953
        • Lewis G.F.
        • Gold M.R.
        Safety and efficacy of the subcutaneous implantable defibrillator.
        J Am Coll Cardiol. 2016; 67: 445-454
        • Olde Nordkamp L.R.A.
        • Brouwer T.F.
        • Barr C.
        • et al.
        Inappropriate shocks in the subcutaneous ICD: incidence, predictors and management.
        Int J Cardiol. 2015; 195: 126-133
        • Boersma L.
        • Barr C.
        • Knops R.
        • et al.
        Implant and midterm outcomes of the subcutaneous implantable cardioverter-defibrillator registry: the EFFORTLESS study.
        J Am Coll Cardiol. 2017; 70: 830-841
        • Brisben A.J.
        • Burke M.C.
        • Knight B.P.
        • et al.
        A new algorithm to reduce inappropriate therapy in the S-ICD system.
        J Cardiovasc Electrophysiol. 2015; 26: 417-423
        • Theuns D.A.M.
        • Brouwer T.F.
        • Jones P.
        • et al.
        A prospective, blinded evaluation of a novel sensing methodology designed to reduce inappropriate shocks by the subcutaneous implantable defibrillator.
        Heart Rhythm. 2018; 15: 1515-1522
        • Brouwer T.F.
        • Yilmaz D.
        • Lindeboom R.
        • et al.
        Long-term clinical outcomes of subcutaneous versus transvenous implantable defibrillator therapy.
        J Am Coll Cardiol. 2016; 68: 2047-2055
        • Berne P.
        • Viola G.
        • Motta G.
        • Marziliano N.
        • Carboni V.
        • Casu G.
        Changing place, changing future: repositioning a subcutaneous implantable cardioverter-defibrillator can resolve inappropriate shocks secondary to myopotential oversensing.
        HeartRhythm Case Rep. 2017; 3: 475-478
        • Corzani A.
        • Ziacchi M.
        • Biffi M.
        • Diemberger I.
        • Martignani C.
        • Boriani G.
        Inappropriate shock for myopotential oversensing in a patient with subcutaneous ICD.
        Indian Heart J. 2015; 67: 56-59
        • Ajiro Y.
        • Shiga T.
        • Shoda M.
        • Hagiwara N.
        Surface electromyography of myopotential oversensing provoked by simultaneous straining and leftward twisting in a patient with an implantable cardioverter defibrillator.
        Heart Vessels. 2017; 32: 364-368
        • Rauwolf T.
        • Guenther M.
        • Hass N.
        • et al.
        Ventricular oversensing in 518 patients with implanted cardiac defibrillators: incidence, complications, and solutions.
        Europace. 2007; 9: 1041-1047
        • Peters R.W.
        • Cooklin M.
        • Brockman R.
        • Shorofsky S.R.
        • Gold M.R.
        Inappropriate shocks from implanted cardioverter defibrillators caused by sensing of diaphragmatic myopotentials.
        J Interv Card Electrophysiol. 1998; 2: 367-370
        • Maeo S.
        • Chou T.
        • Yamamoto M.
        • Kanehisa H.
        Muscular activities during sling- and ground-based push-up exercise.
        BMC Res Notes. 2014; 7: 1-7
        • Migliore F.
        • Allocca G.
        • Calzolari V.
        • et al.
        Intermuscular two-incision technique for subcutaneous implantable cardioverter defibrillator implantation: results from a multicenter registry.
        Pacing Clin Electrophysiol. 2017; 40: 278-285
        • Kutyifa V.
        • Daubert J.P.
        • Schuger C.
        • et al.
        Novel ICD programming and inappropriate ICD therapy in CRT-D versus ICD patients: a MADIT-RIT sub-study.
        Circ Arrhythm Electrophysiol. 2016; 9: 1-8
        • Quast A.-F.
        • van Dijk V.F.
        • Yap S.-C.
        • et al.
        Six-year follow-up of the initial Dutch subcutaneous implantable cardioverter-defibrillator cohort: long-term complications, replacements, and battery longevity.
        J Cardiovasc Electrophysiol. 2018; 29: 1010-1016
        • Burke M.C.
        • Gold M.R.
        • Knight B.P.
        • et al.
        Safety and efficacy of the totally subcutaneous implantable defibrillator: 2-year results from a pooled analysis of the IDE study and EFFORTLESS registry.
        J Am Coll Cardiol. 2015; 65: 1605-1615
        • Van Rees J.B.
        • Borleffs C.J.W.
        • De Bie M.K.
        • et al.
        Inappropriate implantable cardioverter-defibrillator shocks: incidence, predictors, and impact on mortality.
        J Am Coll Cardiol. 2011; 57: 556-562
        • Ahmed A.S.
        • Patel P.J.
        • Bagga S.
        • et al.
        Troubleshooting electromagnetic interference in a patient with centrifugal flow left ventricular assist device and subcutaneous implantable cardioverter defibrillator.
        J Cardiovasc Electrophysiol. 2018; 29: 477-481
        • Chieng D.
        • Stewart B.
        • Paul V.
        Inappropriate shock from myopotentials due to subcutaneous defibrillator (S-ICD) movement confirmed on fluoroscopy with subsequent device pocket revision.
        J Interv Card Electrophysiol. 2018; 53: 263-265
        • Frommeyer G.
        • Reinke F.
        • Eckardt L.
        • Wasmer K.
        Inappropriate shock in a subcutaneous ICD due to interference with a street lantern.
        Int J Cardiol. 2015; 198: 6-8
        • Berkowitz E.J.
        • Pleimann B.E.
        • Rosenfeld L.E.
        Subcutaneous implantable cardioverter defibrillator oversensing and shock delivery due to chest compressions during CPR.
        Pacing Clin Electrophysiol. 2018; 41: 1687-1690
        • Mann D.E.
        • Otto L.
        • Kelly P.A.
        • Reiter M.J.
        Effect of sensing system on the incidence of myopotential oversensing during bradycardia pacing in implantable cardioverter-defibrillator.
        Am J Cardiol. 2000; 85: 1380-1382
        • Secemsky S.I.
        • Hauser R.G.
        • Denes P.
        • Edwards L.M.
        Unipolar sensing abnormalities: incidence and clinical significance of skeletal muscle interference and undersensing in 228 patients.
        Pacing Clin Electrophysiol. 1982; 5: 10-19