Abstract
Inappropriate shocks remain one of the major problems associated with the use of implantable cardioverter defibrillators (ICD). We describe 3 patients who had inappropriate shocks due to oversensing of diaphragmatic myopotentials. In all 3, oversensing could be demonstrated during deep inspiration or Valsalva maneuver. The problem was remedied in one by insertion of a separate rate sensing lead in the right ventricular outflow tract, in the second by decreasing the rate of antibradycardia pacing of the ICD, and in the third by decreasing the sensitivity of the ICD. We conclude that the possibility of sensed diaphragmatic myopotentials should be considered at the time of ICD implant so that appropriate preventive measures can be taken.
Similar content being viewed by others
References
Hamer ME, Clair WK, Wilkinson WE, Greenfield RA, Pritchett LC, Page RL. Evaluation of outpatients experiencing implantable cardioverter defibrillator shocks associated with minimal symptoms. PACE 1994;17:938-943.
Reiter MJ, Mann DE. Sensing and tachyarrhythmia detection problems in implantable cardioverter defibrillators. J Cardiovasc Electrophysiol 1996;7:542-558.
Peters RW, Foster AH, Shorofsky SR, Nolan DA, Gold MR. Spurious discharges due to late insulation break in endocardial sensing leads for cardioverter defibrillators. PACE 1995;18:478-481.
Sticherling C, Klingenheben T, Hohnloser SH. An unusual cause of an ICD shock. PACE 1997;20:2265-2267.
Barold SS, Ong LS, Falkoff MD, Heinle RA. Inhibition of bipolar demand pacemaker by diaphragmatic myopotentials. Circulation 1977;56:679-683.
Barold SS, Falkoff MD, Ong LS, Heinle RA. Diaphragmatic myopotential inhibition in multiprogrammable unipolar and bipolar pacemakers. In: Steinbach K, ed. Cardiac Pacing Proceedings of the VIIIth World Symposium on Cardiac Pacing. Durmstadt, Germany: Steinkopff Verlag, 1983;537-540.
Damle RS, Mann DE, Kelly PA, Landers M J Reiter MJ. Noise during bradycardia pacing with Ventritex implantable cardioverter defibrillators: Role of diaphragmatic myopotentials and clinical implications. Circulation 1997;I-721. (Abstract).
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Peters, R.W., Cooklin, M., Brockman, R. et al. Inappropriate Shocks from Implanted Cardioverter Defibrillators Caused by Sensing of Diaphragmatic Myopotentials. J Interv Card Electrophysiol 2, 367–370 (1998). https://doi.org/10.1023/A:1009768822780
Issue Date:
DOI: https://doi.org/10.1023/A:1009768822780