Mechanisms of inappropriate defibrillator therapy in a modern cohort of remotely monitored patients.


Journal Article

INTRODUCTION: Defibrillator (ICD) technology and monitoring are evolving rapidly. We investigated the mechanisms of inappropriate ICD therapies in a modern cohort of patients followed at our institution via remote monitoring. METHODS: From September 2009 to March 2011, a total of 2,050 ICD patients (19,600 patient-months) were remotely followed. All events (shocks and antitachycardia pacing) were adjudicated by arrhythmia specialists. RESULTS: A total of 249 patients received ICD therapy (34% inappropriate therapy). Inappropriate ICD shocks affected 33 (1.6%) patients. There were a total of 249 inappropriate episodes in 85 patients. Supraventricular tachycardia (SVT) with 1:1 atrioventricular association was the predominant mechanism accounting for 133 episodes in 50 patients, followed by atrial fibrillation (97 episodes in 27 patients). T-wave oversensing (16 episodes in five patients), electromagnetic interference (two episodes in two patients), and ectopic beats (one episode in one patient) accounted for a small proportion of events. There were 35 arrhythmic episodes in five patients that could not be classified, all in patients with single-chamber devices. There were no differences in these results by device manufacturer. CONCLUSIONS: Despite many technological advances, inappropriate ICD shocks still occur but at very low rates and SVT with 1:1 atrioventricular association represents their most common mechanism.

Full Text

Cited Authors

  • Shah, H; Mezu, U; Patel, D; Flanigan, S; Hreybe, H; Adelstein, E; Jain, S; Lang, V; Saba, S

Published Date

  • May 2013

Published In

Volume / Issue

  • 36 / 5

Start / End Page

  • 547 - 552

PubMed ID

  • 23437876

Pubmed Central ID

  • 23437876

Electronic International Standard Serial Number (EISSN)

  • 1540-8159

International Standard Serial Number (ISSN)

  • 0147-8389

Digital Object Identifier (DOI)

  • 10.1111/pace.12101


  • eng