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Myopotential oversensing due to inversion of the DF-1 connectors: reply
Department of Internal Medicine and Cardiology
Medical Clinic II
University of Technology Dresden
Fetscherstr. 76
01307 Dresden
Germany
Tel: +49 351 4501700
Fax: +49 351 4501702
E-mail address: post{at}thomas-rauwolf.de
Department of Internal Medicine and Cardiology
Medical Clinic II
University of Technology Dresden
Fetscherstr. 76
01307 Dresden
Germany
Department of Internal Medicine and Cardiology
Medical Clinic II
University of Technology Dresden
Fetscherstr. 76
01307 Dresden
Germany
Department of Internal Medicine and Cardiology
Medical Clinic II
University of Technology Dresden
Fetscherstr. 76
01307 Dresden
Germany
Thank you for the valid comment. Indeed, the problem of accidental inversion of the DF-1 connectors is resulting in quasi-unipolar configuration of the pace/sense part of the integrated bipolar ICD device. This is a generally accepted phenomenon.1
,2 Clearly, we did not address this specifically in our paper. Therefore, careful connection of the device is essential for correct ICD function.
The described cause of myopotential oversensing, attributed to contraction of the upper limb, has a variety of causes. In our experience, the contraction of the upper limb musculature is associated with other muscle contractions, for instance diaphragmatic, abdominal, and intercostal muscles. An additional aspect is a sensing artefact based on a micro-ICD lead insulation damage with or without lead impedance changes.
In the case reported in Figure 2A,3 a high-energy device (Guidant Prizm HE with 41 J, Guidant/CPI, St Paul, USA) and a double-coil ICD lead system were implanted. The high amplitude of the myopotentials was the reason for an invasive revision of the ICD system. The intraoperative inspection of the leads, header, and connections was evidently not the cause of the malfunction in this specific patient. We decided to implant a new pace/sense lead in a high-septal position in the right ventricle.
With the new configuration, myopotential oversensing was absent during follow-up over the next 2 years.
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[1] Grimm W, Menz V, Hoffmann J, Timmann U, Funck R, Moosdorf R, et al. Complications of third-generation implantable cardioverter defibrillator therapy. Pacing Clin Electrophysiol (1999) 22:206–11.[CrossRef][Medline]
[2] Mann DE, Otto L, Kelly PA, Reiter MJ. Effect of sensing system on the incidence of myopotential oversensing during bradycardia pacing in implantable cardioverter-defibrillators. Am J Cardiol (2000) 85:1380–2.[CrossRef][Web of Science][Medline]
[3] 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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