PREDICTORS OF INAPPROPRIATE SHOCKS FROM IMPLANTABLE
CARDIOVERTER-DEFIBRILLATORS

Introduction: Inappropriate shocks in patients with an implantable cardioverter-defibrillator (ICD) are associated with significant psychological and physical consequences and increased long-term mortality. The aim: To assess predictors associated with inappropriate high-energy discharges of implantable cardioverter-defibrillators. Material and Methods: Retrospective data analysis of 150 patients aged 64.2±12.8 years (84.7% male) admitted to the Hospital Emergency Department due to at least one cardioverter-defibrillator discharge was performed. All of the discharges were inappropriate in the group of 33 patients, and in the group of 117 patients at least one discharge was appropriate. The following data: age, gender, concomitant diseases, type of ICD implantation (primary vs. secondary prevention), type of discharge, number of discharges, serum potassium, and sodium concentration were collected. Results: Patients with only inappropriate discharges were younger, significantly more often had chronic atrial fibrillation, a significantly higher number of discharges, and ischaemic cardiomyopathy. Logistic regression analysis revealed that the occurrence of only inappropriate discharges was related to the number of discharges over three, the age of patients below 60 years, the serum sodium concentration between 135 mEq/L and 142 mEq/L, and the primary type of prevention of sudden cardiac death. Conclusions: 1. Predictors of inappropriate discharges include: age, serum sodium concentration, and primary type of indications for cardioverter-defibrillator implantation. 2. Further research is necessary to determine the influence of disturbances in the sodium economy on the occurrence of appropriate and inappropriate interventions of implantable cardioverter-defibrillators.

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Efficacy and Complications of Subcutaneous versus Conventional Cardioverter Defibrillators: A Systematic Review and Meta-Analysis

Current Cardiology Reviews ◽

10.2174/1573403x17666211208100151 ◽

2021 ◽

Vol 17 ◽

Author(s):

Camilla Silva Araújo ◽

Carla Liz Barbosa Silva ◽

Antônio da Silva Menezes Júnior ◽

Vinícius Araújo Barbosa ◽

Tiago de Almeida Laranjeira ◽

...

Keyword(s):

Systematic Review ◽

Implantable Cardioverter Defibrillator ◽

Heart Defects ◽

Young Patients ◽

Publication Date ◽

Complication Rates ◽

Implantable Cardioverter Defibrillators ◽

Cardioverter Defibrillator ◽

Inappropriate Shocks ◽

Cardioverter Defibrillators

Background/Objectives: Implantable cardioverter defibrillators are used to prevent sudden cardiac death. The subcutaneous implantable cardioverter defibrillator was newly developed to overcome the limitations of the conventional implantable cardioverter defibrillator-transvenous device. The subcutaneous implantable cardioverter defibrillator is indicated for young patients with heart disease, congenital heart defects, and poor venous access, who have an indication for implantable cardioverter defibrillator without the need for anti-bradycardic stimulation. We aimed to compare the efficacy and complications of subcutaneous with transvenous implantable cardioverter defibrillator devices. Methodology: A systematic review was conducted using different databases. The inclusion criteria were observational and clinical randomized trials with no language limits and no publication date limit that compared subcutaneous with transvenous implantable cardioverter defibrillators. The selected patients were aged > 18 years with complex ventricular arrhythmia. Results : Five studies involving 2111 patients who underwent implantable cardioverter defibrillator implantation were included. The most frequent complication in the subcutaneous device group was infection, followed by hematoma formation and electrode migration. For the transvenous device, the most frequent complications were electrode migration and infection. Regarding efficacy, the total rates of appropriate shocks were 9.04% and 20.47% in the subcutaneous and transvenous device groups, respectively, whereas inappropriate shocks to the subcutaneous and transvenous device groups were 11,3% and 10,7%, respectively. Conclusion: When compared to the transvenous device, the subcutaneous device had lower complication rates owing to lead migration and less inappropriate shocks due to supraventricular tachycardia; nevertheless, infection rates and improper shocks due to T wave oversensing were comparable for both devices

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Twiddler’s syndrome with a subcutaneous implantable cardioverter-defibrillator presenting with an inappropriate shock: a case report

European Heart Journal - Case Reports ◽

10.1093/ehjcr/ytz200 ◽

2019 ◽

Author(s):

C Fielder Camm ◽

Kim Rajappan ◽

Mark Curson ◽

Lindsey Tilling

Keyword(s):

Cardiac Arrhythmias ◽

Idiopathic Dilated Cardiomyopathy ◽

Implantable Cardioverter Defibrillators ◽

Inappropriate Shock ◽

Cardioverter Defibrillator ◽

Inappropriate Shocks ◽

Case Summary ◽

Patients At Risk ◽

Twiddler’S Syndrome ◽

Cardioverter Defibrillators

Abstract Background Subcutaneous implantable cardioverter-defibrillators (S-ICDs) are increasingly used in patients at risk of fatal cardiac arrhythmias. Twiddler’s syndrome is a condition in which a device is manipulated by the patient after implantation leading to lead twisting and retraction. Device manipulation has been reported multiple times in transvenous pacing systems and occasionally leads to inappropriate discharges from implanted defibrillators. However, little has been reported about device manipulation in S-ICD devices. Case summary We present the case of a 16-year-old who underwent insertion of an S-ICD for idiopathic dilated cardiomyopathy. He represented for a pacing check following a discharge from the device. This showed a significant change in the sensed vectors. Chest radiographs confirmed lead retraction and suggested device manipulation. The device was turned off to prevent further inappropriate shocks. The patient underwent successful reimplantation of a S-ICD device. Discussion This case highlights that twiddler’s syndrome can occur in those with an S-ICD and lead to an inappropriate device discharge. The patient in this case had a number of risk factors that have been previously associated with twiddler’s syndrome.

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Implantable cardioverter defibrillator principles

Oxford Specialist Handbook of Pacemakers and ICDs 2e ◽

10.1093/med/9780199687831.003.0009 ◽

2018 ◽

pp. 183-218

Author(s):

Rajesh Chelliah ◽

Raj Khiani

Keyword(s):

Pulse Generator ◽

Home Monitoring ◽

Evidence Base ◽

Detection Sensitivity ◽

Implantable Cardioverter Defibrillators ◽

Arrhythmia Detection ◽

Cardioverter Defibrillator ◽

Inappropriate Shocks ◽

Potential Problems ◽

Cardioverter Defibrillators

This chapter covers the principles of implantable cardioverter defibrillators (ICDs). Indications and potential problems for insertion of an ICD are described, including the evidence base for insertion based on randomized trials. International clinical guidelines are summarized. The mechanism and components of an ICD are defined, including diagrams to show the pulse generator, electrodes, and a section on which lead to choose. Arrhythmia detection, sensitivity, oversensing, and rate determination are all discussed. Supraventricular tachycardia (SVT) discriminators, pacing for anti-tachycardia and bradycardia, anti-tachycardia pacing (ATP) delivery, defibrillation, and configuration of shock vector are covered. The importance of avoiding inappropriate shocks is briefly outlined, and strategies for home monitoring are featured.

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Delivering an efficient and effective support group for patients with implantable cardioverter-defibrillators (ICDs): patient perspectives of key concerns and predictors of inclination to attend

BMC Health Services Research ◽

10.1186/s12913-021-06735-3 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Kathryn Murray ◽

Kelly Buttigieg ◽

Michelle Todd ◽

Vicky McKechnie

Keyword(s):

Support Groups ◽

Support Group ◽

Qualitative Data ◽

Implantable Cardioverter Defibrillators ◽

Cardioverter Defibrillator ◽

And Coping ◽

Patients Experience ◽

The Impact ◽

Cardioverter Defibrillators ◽

Patient Concerns

Abstract Background A subset of patients experience psychological distress following insertion of an implantable cardioverter-defibrillator (ICD) and ICD support groups are recommended, however access to these groups is limited. This study aimed: to gauge a better understanding of patients’ key ICD-related concerns; to determine patient interest in a support group and topics deemed helpful to address in a support group; and to examine factors which affect patient inclination to attend. Methods One hundred and thirty nine patients completed the ICD Patient Concerns Questionnaire – Brief (ICDC-B) and a semi-structured survey. Non-parametric tests were used to examine associations and differences in the quantitative data. Qualitative data were analysed using thematic analysis. Results 42% of respondents said they would attend a support group and inclination to attend was associated with higher ICD concerns and a shorter time since implant. Topics considered important to address in a group were information about heart conditions and devices, the impact of an ICD on daily life and coping with fear of shocks. Conclusion We concluded that there is interest in further support amongst many patients and that ICD support groups may be delivered efficiently by targeting patients who have higher levels of ICD concerns and within the first few years after implant.

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Risk factors for hepatic encephalopathy in patients with cirrhosis and refractory ascites: relevance of serum sodium concentration

Liver International ◽

10.1111/j.1478-3231.2010.02293.x ◽

2010 ◽

Vol 30 (8) ◽

pp. 1137-1142 ◽

Cited By ~ 53

Author(s):

Mónica Guevara ◽

María E. Baccaro ◽

Jose Ríos ◽

Marta Martín-Llahí ◽

Juan Uriz ◽

...

Keyword(s):

Risk Factors ◽

Hepatic Encephalopathy ◽

Serum Sodium ◽

Sodium Concentration ◽

Serum Sodium Concentration ◽

Refractory Ascites

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Transvenous and non-transvenous implantable cardioverter-defibrillators in children, adolescents, and adults with congenital heart disease: who is at risk for appropriate and inappropriate shocks?

EP Europace ◽

10.1093/europace/euy219 ◽

2018 ◽

Vol 21 (1) ◽

pp. 106-113 ◽

Cited By ~ 7

Author(s):

Ulrich Krause ◽

Matthias J Müller ◽

Yannic Wilberg ◽

Matthias Pietzka ◽

David Backhoff ◽

...

Keyword(s):

At Risk ◽

Congenital Heart Disease ◽

Heart Disease ◽

Congenital Heart ◽

Implantable Cardioverter Defibrillators ◽

Inappropriate Shocks ◽

Adolescents And Adults ◽

Cardioverter Defibrillators

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Electromagnetic Interference with Implantable Cardioverter Defibrillators Causing Inadvertent Shock: Case Report and Review of Current Literature

Clinical Medicine Insights Cardiology ◽

10.4137/cmc.s10990 ◽

2014 ◽

Vol 8 ◽

pp. CMC.S10990 ◽

Cited By ~ 7

Author(s):

Muhammad Akhtar ◽

Tariq Bhat ◽

Mohmad Tantray ◽

Chris Lafferty ◽

Saiful Faisal ◽

...

Keyword(s):

Case Report ◽

Implantable Cardioverter Defibrillator ◽

Current Literature ◽

Electromagnetic Interference ◽

Interesting Case ◽

Implantable Cardioverter Defibrillators ◽

Normal Functioning ◽

Cardioverter Defibrillator ◽

Number Of Patients ◽

Cardioverter Defibrillators

As the number of patients having implantable cardioverter defibrillator (ICD) devices is increasing, it is important for the physicians and patients to be aware of situations and conditions that can result in interference with normal functioning of these devices. There are multiple cases of malfunction of ICDs reported in literature and it may be of great significance to have an overview of these incidents for appropriate recognition and future prevention. Here we are reviewing the available literature as well as reporting an interesting case of electromagnetic interference (EMI) resulting from leak of current in pool water causing firing of ICD.

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