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Ventricular oversensing in 518 patients with implanted cardiac defibrillators: incidence, complications, and solutions
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Rauwolf et al.1
report a 1.5% incidence of myopotential oversensing in their series of 518 ICD patients. The causes for myopotential oversensing were attributed either to contraction of respiratory muscles (by the diaphragm, which is in proximity to the ICD lead tip at the apex) or to contraction of the upper limb/trunk muscles (as was the case in the example shown in Fig. 2A). The latter finding is possible only when an integrated bipolar ICD lead is used with accidental inversion of the DF-1 connectors at implantation. In integrated bipolar leads, the distal (negative) DF-1 lead terminal supplies the anode for rate sensing. As the positive DF-1 connector is internally connected to the ICD casing, accidental inversion of the DF-1 lead terminals will result in the ICD casing becoming part of the sensing circuit. Therefore, myopotential activity may be sensed during contraction of the pectoral muscles, with a risk of inappropriate shocks. Furthermore, DF-1 lead inversion results in the presence of a shock vector directed between the SVC coil and the ICD casing that may shunt energy away from the ventricles, resulting in ineffective therapy. Owing to this, the DF-1 connections should be corrected, rather than simply modifying sensitivity settings to avoid inappropriate shocks.
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[1] Rauwolf T, Guenther M, Hass N, Schnabel A, Bock M, Braun MU, et al. Ventricular oversensing in 518 patients with implanted cardiac defibrillators: incidence, complications, and solutions. Europace (2007) 9:1041–7.
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