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Europace Advance Access published online on March 16, 2007
Europace, doi:10.1093/europace/eum028
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© The European Society of Cardiology 2007. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

CASE REPORT

Unusual cause for an increase of the sensing integrity counter in a patient with inappropriate implantable cardioverter-defibrillator therapy

Dirk Vollmann*, Lars Lüthje and Markus Zabel

Abteilung Kardiologie und Pneumologie, Herzzentrum, Klinikum der Georg-August Universität Göttingen, Robert-Koch-Strasse 40, 37075 Göttingen, Germany

We describe the case of a patient who presented with multiple implantable cardioverter-defibrillator (ICD) shock discharges 12 months after device implantation. Upon device interrogation, intermittent oversensing of electrical noise and potential ICD lead failure were suggested by a significant increase in the sensing integrity counter (SIC), a cumulative count of very short ventricular sensed intervals. Analysis of stored episodes, however, revealed that inappropriate ICD therapy had been caused by intermittent T-wave oversensing (TWO), and that the increase of the SIC resulted from the coincidence of TWO and premature ventricular complexes (PVCs). T-wave oversensing resolved and the SIC did not increase any more during follow-up after adjustment of ventricular sensitivity. The coincidence of TWO and PVCs should therefore be considered as an uncommon cause for short ventricular sensed intervals in ICD patients presenting with a suspect increase in the SIC.

Key Words: Implantable-cardioverter defibrillator, Oversensing, Inappropriate therapy, Sensing integrity counter

* Corresponding author. Tel: +49 551 39 9625; fax: +49 551 39 9628. E-mail address: dirkvollmann2000{at}aol.com

Manuscript submitted 16 October 2006. Accepted after revision 2 February 2007.


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