Skip to main content

Advertisement

Log in

Methods of minimizing inappropriate implantable cardioverter-defibrillator shocks

  • Published:
Current Cardiology Reports Aims and scope Submit manuscript

Abstract

As more and more patients receive complex implantable cardioverter-defibrillators (ICDs), profound knowledge about the incidence of inappropriate device therapy, the reasons it happens, and the possibilities for prevention is crucial. In this article, the most important prevention algorithms incorporated in current ICD models and their advantages and handicaps are discussed in detail, which should help to guide the device selection for a particular patient. Also, emphasis is put on adjunctive drug therapy and interventional treatment strategies, which are crucial in managing patients with inappropriate ICD shocks.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References and Recommended Reading

  1. Grimm W, Flores BF, Marchlinski FE: Electrocardiographically documented unnecessary, spontaneous shocks in 241 patients with implantable cardioverter defibrillators. Pacing Clin Electrophysiol 1992, 15:1667–1673.

    Article  PubMed  CAS  Google Scholar 

  2. Mattke S, Dorwarth U, Muller D, et al.: [Inadequate therapeutic effects of implantable cardioverter/defibrillators: etiology, therapy and prevention]. Z Kardiol 1994, 83:359–365.

    PubMed  CAS  Google Scholar 

  3. O'Nunain SO, Roelke M, Trouton T, et al.: Limitations and late complications of third-generation automatic cardioverter-defibrillators. Circulation 1995, 91:2204–2213.

    Google Scholar 

  4. Weber M, Block M, Brunn J, et al.: [Inadequate therapies with implantable cardioverter-defibrillators-- incidence, etiology, predictive factors and preventive strategies]. Z Kardiol 1996, 85:809–819.

    PubMed  CAS  Google Scholar 

  5. Rosenqvist M, Beyer T, Block M, et al.: Adverse events with transvenous implantable cardioverter-defibrillators: a prospective multicenter study. European 7219 Jewel ICD investigators [published erratum appears in Circulation 1998, 98:2647]. Circulation 1998, 98:663–670.

    PubMed  CAS  Google Scholar 

  6. Grimm W, Menz V, Hoffmann J, et al.: Complications of third-generation implantable cardioverter defibrillator therapy. Pacing Clin Electrophysiol 1999, 22:206–211.

    Article  PubMed  CAS  Google Scholar 

  7. Goldberger JJ, Horvath G, Challapalli R, Kadish AH: Inappropriate implantable cardioverter-defibrillator therapy due to the detection of premature ventricular complexes. Pacing Clin Electrophysiol 1999, 22:825–828.

    Article  PubMed  CAS  Google Scholar 

  8. Schaumann A: Managing atrial tachyarrhythmias in patients with implantable cardioverter defibrillators. Am J Cardiol 1999, 83:214D-217D. This paper gives an excellent review about the prevention algorithms to avoid IDT. The key message is that IDT rates could drop to 5% if all options were activated.

    Article  PubMed  CAS  Google Scholar 

  9. Neuzner J, Pitschner HF, Schlepper M: Programmable VT detection enhancements in implantable cardioverter defibrillator therapy. Pacing Clin Electrophysiol 1995, 18:539–547.

    Article  PubMed  CAS  Google Scholar 

  10. Swerdlow CD, Ahern T, Chen PS, et al.: Underdetection of ventricular tachycardia by algorithms to enhance specificity in a tiered-therapy cardioverter-defibrillator. J Am Coll Cardiol 1994, 24:416–424.

    Article  PubMed  CAS  Google Scholar 

  11. Higgins SL, Lee RS, Kramer RL: Stability: an ICD detection criterion for discriminating atrial fibrillation from ventricular tachycardia. J Cardiovasc Electrophysiol 1995, 6:1081–1088.

    Article  PubMed  CAS  Google Scholar 

  12. Brugada J: Is inappropriate therapy a resolved issue with current implantable cardioverter defibrillators? Am J Cardiol 1999, 83:40D-44D. This paper summarizes many of the established discrimination criteria used to avoid IDT. In addition, results with different stability and onset parameters are extensively described.

    Article  PubMed  CAS  Google Scholar 

  13. Weber M, Bocker D, Bansch D, et al.: Efficacy and safety of the initial use of stability and onset criteria in implantable cardioverter defibrillators. J Cardiovasc Electrophysiol 1999, 10:145–153. In this study, the authors show convincingly that stability and onset criteria can safely be programmed immediately after implantation. However, they emphasize that these criteria should only be used for VT zones that are hemodynamically tolerated by the patient, because there was a small percentage of delayed or missed VT therapy.

    Article  PubMed  CAS  Google Scholar 

  14. Duru F, Schonbeck M, Lüscher TF, Candinas R: The potential of inappropriate ventricular tachycardia confirmation using the intracardiac electrogram (EGM) width criterion. PACE 1999, 22:1039–1046.

    PubMed  CAS  Google Scholar 

  15. Brachmann J, Seidl KH, Hauer B, et al.: Intracardiac eletrogram width measurement for improved tachycardia discrimination: initial results of a new implantable cardioverterdefibrillator (ICD). J Am Coll Cardiol 1996, 27:97A.

    Article  Google Scholar 

  16. Gold MR, Hsu W, Marcovecchio AF, et al.: A new defibrillator discrimination algorithm utilizing electrogram morphology analysis. Pacing Clin Electrophysiol 1999, 22:179–182. In this paper the theory of the "“SimDis”" algorithm is outlined and first results are presented.

    Article  PubMed  CAS  Google Scholar 

  17. Nayak HM, Tsao L, Santoni-Rugiu F, et al.: A pitfall in using far-field bipolar electrograms in arrhythmia discrimination in a patient with an implantable cardioverter defibrillator. Pacing Clin Electrophysiol 1997, 20:2864–2866.

    Article  PubMed  CAS  Google Scholar 

  18. Best PJ, Hayes DL, Stanton MS: The potential usage of dual chamber pacing in patients with implantable cardioverter defibrillators. Pacing Clin Electrophysiol 1999, 22:79–85.

    Article  PubMed  CAS  Google Scholar 

  19. Geelen P, Lorga Filho A, Chauvin M, et al.: The value of DDD pacing in patients with an implantable cardioverter defibrillator. Pacing Clin Electrophysiol 1997, 20:177–181.

    Article  PubMed  CAS  Google Scholar 

  20. Kuhlkamp V, Dornberger V, Mewis C, et al.: Clinical experience with the new detection algorithms for atrial fibrillation of a defibrillator with dual chamber sensing and pacing. J Cardiovasc Electrophysiol 1999, 10:905–915. This paper compares detection algorithms in the CPI-Guidant ICDs Ventak AV (dual-chamber) and Ventak mini (single-chamber). For the dual-chamber ICD used in this study, the results regarding SVT/AF discrimination were disappointing, as there was no reduction in inappropriate therapy. Safety for VT therapy was nevertheless assured.

    Article  PubMed  CAS  Google Scholar 

  21. Osswald S, Deno C, Barbosa V, et al.: Clinical evaluation of a dual chamber atrial discrimination algorithm (ADA) governing ICD therapy. Arch Mal Coeur Vais 1998, 91:III:179.

    Google Scholar 

  22. Osswald S, Cron TA, Sterns L, et al.: New ICD-technologies: first clinical experience with dual-chamber sensing for differentiation of supraventricular tachyarrhythmias. Pacing Clin Electrophysiol 1998, 21:292–295.

    Article  PubMed  CAS  Google Scholar 

  23. Gillberg JM, Gunderson BD, Brown ML, et al.: Dual chamber versus single-chamber ventricular tachyarrhythmia detection: a retrospective comparison. PACE 1998, 21:909.

    Google Scholar 

  24. Swerdlow CD, Sheth NV, Olson WH, et al.: Clinical performance of a pattern-based, dual-chamber algorithm for discrimination of ventricular from supraventricular arrhythmias. PACE 1998, 21:800.

    Google Scholar 

  25. Strickberger SA, Man KC, Daoud E, et al.: A prospective evaluation of Catheter Ablation of ventricular tachycardia as adjuvant therapy in patients with coronary artery disease and an implantable cardioverter-defibrillator. Circulation 1997, 96:1525–1531.

    PubMed  CAS  Google Scholar 

  26. Schumacher B, Tebbenjohanns J, Jung W, et al.: Radiofrequency catheter ablation of atrial flutter that elicits inappropriate implantable cardioverter defibrillator discharge. Pacing Clin Electrophysiol 1997, 20:125–127.

    Article  PubMed  CAS  Google Scholar 

  27. Jordaens L, Caenepeel A, Calle P: His bundle ablation for supraventricular arrhythmias to avoid spurious shocks of an implanted defibrillator. Clin Cardiol 1992, 15:693–695.

    Article  PubMed  CAS  Google Scholar 

  28. Pacifico A, Hohnloser SH, Williams JH, et al.: Prevention of implantable-defibrillator shocks by treatment with sotalol. d,l-Sotalol Implantable Cardioverter-Defibrillator Study Group [see comments]. N Engl J Med 1999, 340:1855–1862. Important double-blind study that assessed the value of sotalol treatment for the prevention of ICD shocks and improvement of survival.

    Article  PubMed  CAS  Google Scholar 

  29. Seidl K, Hauer B, Schwick NG, et al.: Comparison of metoprolol and sotalol in preventing ventricular tachyarrhythmias after the implantation of a cardioverter/defibrillator. Am J Cardiol 1998, 82:744–748.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

About this article

Cite this article

Schaer, B., Osswald, S. Methods of minimizing inappropriate implantable cardioverter-defibrillator shocks. Curr Cardiol Rep 2, 346–352 (2000). https://doi.org/10.1007/s11886-000-0092-4

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11886-000-0092-4

Keywords

Navigation