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Failure to detect life‐threatening arrhythmias in ICDs using single‐chamber detection criteria

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Abstract
Background: There are anecdotal reports of sudden death despite a functional implantable cardioverter defibrillator (ICD). We sought to describe scenarios leading to fatal or near-fatal outcome due to inappropriately inhibited ICD therapy in devices programmed with single-chamber detection criteria. Methods: Programmed settings, episode lists, and intracardiac electrograms from 24 patients with a life-threatening event (n = 12) or fatal outcome (n = 12) related to failed ventricular arrhythmia detection were used to clarify the underlying scenario. Results: Fifty episodes of failed ventricular arrhythmia detection were identified and categorized into six scenarios: (1) spontaneous ventricular tachycardia (VT) or ventricular fibrillation (VF) with a rate below the detection limits, (2) misclassification of polymorphic VT (PVT) or VF as supraventricular tachycardia (SVT), (3) misclassification of VT/VF as cluster of nonsustained VT episodes, (4) misclassification of monomorphic VT (MVT) as SVT, (5) inappropriate shock abortion, and (6) false termination detection. These scenarios occurred respectively 6, 9, 3, 9, 8, and 15 times. In 9/9 (100%) patients with PVT/VF classified as SVT, rate stability was active for rates ranging from 222 to 250 beats/min. MVT detected as SVT was due to the sudden onset criterion in 7/9 (78%) patients and twice a consequence of the rate stability criterion active for rates ranging from 200 to 250 beats/min. Conclusion: We describe six scenarios leading to failure of ventricular arrhythmia detection in a single-chamber detection setting withholding life-saving therapy. These scenarios are more likely to occur with high-rate programming and long detection times, especially if combined with rate stability and sudden onset.
Keywords
device programming, forensic medicine, implantable cardioverter defibrillator, sudden cardiac death, ventricular arrhythmia, IMPLANTABLE CARDIOVERTER-DEFIBRILLATORS, PRIMARY PREVENTION PATIENTS, VENTRICULAR-TACHYCARDIA, THERAPY, INAPPROPRIATE, ALGORITHMS, SHOCKS, DISCRIMINATION, TRIAL, DEATH

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MLA
Stroobandt, Roland et al. “Failure to Detect Life‐threatening Arrhythmias in ICDs Using Single‐chamber Detection Criteria.” PACE-PACING AND CLINICAL ELECTROPHYSIOLOGY 42.6 (2019): 583–594. Print.
APA
Stroobandt, R., Duytschaever, M., Strisciuglio, T., Van Heuverswyn, F., Timmers, L., De Pooter, J., Knecht, S., et al. (2019). Failure to detect life‐threatening arrhythmias in ICDs using single‐chamber detection criteria. PACE-PACING AND CLINICAL ELECTROPHYSIOLOGY, 42(6), 583–594.
Chicago author-date
Stroobandt, Roland, Mattias Duytschaever, Teresa Strisciuglio, Frederic Van Heuverswyn, Liesbeth Timmers, Jan De Pooter, Sébastien Knecht, Yves R Vandekerckhove, Andreas Kucher, and Rene H Tavernier. 2019. “Failure to Detect Life‐threatening Arrhythmias in ICDs Using Single‐chamber Detection Criteria.” Pace-pacing and Clinical Electrophysiology 42 (6): 583–594.
Chicago author-date (all authors)
Stroobandt, Roland, Mattias Duytschaever, Teresa Strisciuglio, Frederic Van Heuverswyn, Liesbeth Timmers, Jan De Pooter, Sébastien Knecht, Yves R Vandekerckhove, Andreas Kucher, and Rene H Tavernier. 2019. “Failure to Detect Life‐threatening Arrhythmias in ICDs Using Single‐chamber Detection Criteria.” Pace-pacing and Clinical Electrophysiology 42 (6): 583–594.
Vancouver
1.
Stroobandt R, Duytschaever M, Strisciuglio T, Van Heuverswyn F, Timmers L, De Pooter J, et al. Failure to detect life‐threatening arrhythmias in ICDs using single‐chamber detection criteria. PACE-PACING AND CLINICAL ELECTROPHYSIOLOGY. 2019;42(6):583–94.
IEEE
[1]
R. Stroobandt et al., “Failure to detect life‐threatening arrhythmias in ICDs using single‐chamber detection criteria,” PACE-PACING AND CLINICAL ELECTROPHYSIOLOGY, vol. 42, no. 6, pp. 583–594, 2019.
@article{8615682,
  abstract     = {Background: There are anecdotal reports of sudden death despite a functional implantable cardioverter defibrillator (ICD). We sought to describe scenarios leading to fatal or near-fatal outcome due to inappropriately inhibited ICD therapy in devices programmed with single-chamber detection criteria.
Methods: Programmed settings, episode lists, and intracardiac electrograms from 24 patients with a life-threatening event (n = 12) or fatal outcome (n = 12) related to failed ventricular arrhythmia detection were used to clarify the underlying scenario.
Results: Fifty episodes of failed ventricular arrhythmia detection were identified and categorized into six scenarios: (1) spontaneous ventricular tachycardia (VT) or ventricular fibrillation (VF) with a rate below the detection limits, (2) misclassification of polymorphic VT (PVT) or VF as supraventricular tachycardia (SVT), (3) misclassification of VT/VF as cluster of nonsustained VT episodes, (4) misclassification of monomorphic VT (MVT) as SVT, (5) inappropriate shock abortion, and (6) false termination detection. These scenarios occurred respectively 6, 9, 3, 9, 8, and 15 times. In 9/9 (100%) patients with PVT/VF classified as SVT, rate stability was active for rates ranging from 222 to 250 beats/min. MVT detected as SVT was due to the sudden onset criterion in 7/9 (78%) patients and twice a consequence of the rate stability criterion active for rates ranging from 200 to 250 beats/min.
Conclusion: We describe six scenarios leading to failure of ventricular arrhythmia detection in a single-chamber detection setting withholding life-saving therapy. These scenarios are more likely to occur with high-rate programming and long detection times, especially if combined with rate stability and sudden onset.},
  author       = {Stroobandt, Roland and Duytschaever, Mattias and Strisciuglio, Teresa and Van Heuverswyn, Frederic and Timmers, Liesbeth and De Pooter, Jan and Knecht, Sébastien and Vandekerckhove, Yves R and Kucher, Andreas and Tavernier, Rene H},
  issn         = {0147-8389},
  journal      = {PACE-PACING AND CLINICAL ELECTROPHYSIOLOGY},
  keywords     = {device programming,forensic medicine,implantable cardioverter defibrillator,sudden cardiac death,ventricular arrhythmia,IMPLANTABLE CARDIOVERTER-DEFIBRILLATORS,PRIMARY PREVENTION PATIENTS,VENTRICULAR-TACHYCARDIA,THERAPY,INAPPROPRIATE,ALGORITHMS,SHOCKS,DISCRIMINATION,TRIAL,DEATH},
  language     = {eng},
  number       = {6},
  pages        = {583--594},
  title        = {Failure to detect life‐threatening arrhythmias in ICDs using single‐chamber detection criteria},
  url          = {http://dx.doi.org/10.1111/pace.13610},
  volume       = {42},
  year         = {2019},
}

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