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Noise from a dysfunctional atrial lead detected as atrial fibrillation by a cardiac implantable electronic device

Detektion von Störsignalen einer defekten atrialen Elektrode als Vorhofflimmern durch einen implantierbaren Zweikammer-Kardioverter-Defibrillator

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An Erratum to this article was published on 23 February 2017

Abstract

A patient with a dual chamber implantable cardioverter–defibrillator developed a defective atrial lead whereupon the generated false atrial signals were repeatedly interpreted as atrial tachycardia/atrial fibrillation (AF) by the atrial upper rate algorithm coupled with rare episodes of noise reversion. This unusual response highlights the limitations of the upper atrial rate triggers of device diagnosis of supraventricular tachyarrhythmias. The converse may occur with a very fine AF or with a very sensitive sensitivity setting (e. g., 0.1 mV) when AF can be detected as noise.

Zusammenfassung

Ein Patient mit einem Zweikammer-ICD (implantierbaren Kardioverter-Defibrillator) entwickelte einen atrialen Elektrodendefekt. Das dadurch verursachte Artefakt wurde vom Gerät wiederholt als atriale Tachykardie bzw. Vorhofflimmern interpretiert, nur in seltenen Fällen als Störsignal. Diese ungewöhnliche Reaktion unterstreicht die Limitationen der Erkennung von supraventrikulären Tachykardien oberhalb der oberen Grenzfrequenz durch automatische Algorithmen. Umgekehrt kann sehr hochfrequentes Vorhofflimmern bei sehr empfindlicher Einstellung (z. B. 0,1 mV) als Störgeräusch fehlklassizifiziert werden.

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Notes

  1. Bradycardia and Tachycardia Devices. Merlin™ Patient Care System. St Jude Medical, Sylmar, California. 2015.

  2. Filtered Atrial Rate Interval (FARI). Technical insight. St Jude Medical, Sylmar, California. November 2015.

  3. Bradycardia and Tachycardia Devices. Merlin™ Patient Care System (see comment #1).

  4. Rate-Responsive PVARP – High. The new API!. Endurity™, Assurity™, and Allure™. Technical insight. St Jude Medical, Sylmar, California. September 2014.

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Author information

Authors and Affiliations

  1. Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA

    S. Serge Barold MD

  2. Heart Center, Ghent University Hospital, Ghent, Belgium

    F. Van Heuverswyn

Authors
  1. S. Serge Barold MD
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  2. F. Van Heuverswyn
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Corresponding author

Correspondence to S. Serge Barold MD.

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Conflict of interest

S. Serge Barold and F. Van Heuverswyn declare that they have no competing interests.

The accompanying manuscript does not include studies on humans or animals.

Additional information

An erratum to this article is available at http://dx.doi.org/10.1007/s00399-017-0496-0.

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Serge Barold, S., Van Heuverswyn, F. Noise from a dysfunctional atrial lead detected as atrial fibrillation by a cardiac implantable electronic device. Herzschr Elektrophys 27, 326–328 (2016). https://doi.org/10.1007/s00399-016-0435-5

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  • DOI: https://doi.org/10.1007/s00399-016-0435-5

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