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Europace Advance Access published online on May 3, 2007
Europace, doi:10.1093/europace/eum056
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© The European Society of Cardiology 2007. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

CASE REPORT

An unusual mechanism causing inappropriate implantable cardioverter defibrillator shocks: transient reduction in R-wave amplitude

Adrian Baranchuk*, Sebastian Ribas, Syamkumar Divakaramenon and Carlos A. Morillo

Arrhythmia Service, McMaster University, Hamilton Health Sciences Corporation, Hamilton, Ontario, Canada

Inappropriate shocks delivered by the implantable cardioverter defibrillator (ICD) are an increasingly recognized complication. The most frequent cause is related to supraventricular rhythms associated with fast conduction to the ventricles that are incorrectly detected as ventricular tachycardia leading to inappropriate antitachycardia pacing and/or shocks. Oversensing is a frequent cause of inappropriate shocks usually due to increased amplitude of the T-wave secondary to ischaemia or electrolyte disorders that lead to T-wave double counting.We describe an unusual case of T-wave double counting during sinus rhythm caused by transient reduction in R-wave amplitude with no changes in T-wave amplitude resulting in inappropriate shocks.

Key Words: ICD-inappropriate shocks, Transient reduction in R-wave amplitude

* Corresponding author: Cardiac Electrophysiology and Pacing, Kingston General Hospital, Queen's University, 861 Apple Down Dr, Kingston, Ontario, Canada K7L 2V7. Tel: +1 613 549 6666/ext 3801; fax: +1 613 548 1387. E-mail address: barancha{at}kgh.kari.net

Manuscript submitted 5 December 2006. Accepted after revision 8 March 2007.


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