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Europace Advance Access published online on August 30, 2008
Europace, doi:10.1093/europace/eun241
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2008. For permissions please email: journals.permissions@oxfordjournals.org

Diaphragmatic myopotential oversensing in pacemaker-dependent patients with CRT-D devices

Katya Reis Santos*, Pedro Adragão, Diogo Cavaco, Francisco Bello Morgado, Rui Candeias, Sónia Lima and José Aniceto Silva

Hospital Santa Cruz, Centro Hospitalar de Lisboa Ocidental, EPE, Avenida Professor Reinaldo dos Santos, 2790-134 Carnaxide, Portugal

Aims: To evaluate the incidence and clinical significance of diaphragmatic myopotential (dMP) oversensing in pacemaker (PM)-dependent patients with CRT-Ds.

Methods and results: We retrospectively evaluated patients with CRT-Ds implanted at our institution between January 2000 and August 2006. PM-dependent patients were identified, and the incidence of inappropriate detections due to dMP oversensing and their possible clinical implications (inappropriate therapies, syncope, and death of any cause) were evaluated. CRT-Ds were implanted in 122 patients, 37 were or became PM dependent. During a mean follow-up of 22 ± 17 months, 7(18.9%) PM-dependent patients revealed inappropriate detections due to dMP oversensing. All oversensing episodes occurred in CRT-Ds with automatic gain control (AGC) sensing and integrated bipolar (IBP) leads in the RV apex. These detections led to inappropriate shocks in 2(5.4%) patients and syncope in 1(2.7%). Five (13.5%) patients died.

Conclusion: dMP oversensing in PM-dependent patients with CRT-Ds is an important problem, particularly in CRT-Ds with AGC sensing and IBP leads, with over 20% of patients with these devices revealing inappropriate detections. The clinical impact of dMP oversensing is less marked but relevant, with both inappropriate therapies and syncope occurring in this small group of 37 patients and the possibility of related deaths.

Key Words: Diaphragmatic myopotentials, Oversensing, Cardiac resynchronization and defibrillation therapy

* Corresponding author: Rua Sam Levy, Empreendimento Villa Restelo, Apartamento No. 67, 1400-391 Lisboa, Portugal. Tel: +351 91 9052200. E-mail address: katyars{at}netcabo.pt

Manuscript submitted 6 June 2008. Accepted after revision 6 August 2008.


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