Catastrophic implantable cardioverter-defibrillator misclassification of ventricular tachycardia
  • Zhafran Veliawan
    Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Brawijaya, Saiful Anwar General Hospital, Malang, Indonesia
  • Ardian Rizal
    Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Brawijaya, Saiful Anwar General Hospital, Malang, Indonesia
  • Indra Prasetya
    Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Brawijaya, Saiful Anwar General Hospital, Malang, Indonesia
  • Adhika Prastya
    Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Brawijaya, Saiful Anwar General Hospital, Malang, Indonesia

Keywords

Morphology discrimination, supraventricular tachycardia, ventricular tachycardia, ICD misclassification

Abstract

Inappropriate therapy is a frequent adverse consequence of implantable cardioverter-defibrillator. Inappropriate therapy often occurs due to the misinterpretation of sinus tachycardia or atrial fibrillation/flutter with rapid atrioventricular conduction by the device. Current implantable cardioverter-defibrillator (ICD) mechanisms integrate various discriminators into algorithms to differentiate supraventricular tachycardia (SVT) from ventricular tachycardia (VT), to prevent such occurrences. A 40-year-old man suffered seizures and cardiac arrest abruptly, without prior complaints of chest pain. Without delay, he initiated cardiopulmonary resuscitation (CPR), resulting in the regaining of spontaneous circulation. The patient had previously received a single-chamber ICD due to recurring VT and a prior episode of cardiac arrest. The patient had a medical background of coronary artery disease with complete revascularisation and no previous occurrence of SVT. Interrogating the ICD revealed captured non-sustained ventricular tachycardia (NSVT) and SVT events but no VT episode or shock therapy. During the specified time period, the patient underwent an electrophysiological study, and no SVT was induced with the normal function of the atrioventricular and sinoatrial nodes. Various causes can lead to errors in morphology discrimination criteria in single-chamber ICDs. Extending the detection interval is highly recommended to avoid misclassification of ICDs.

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    Published: 2024-05-20
    Issue: 2024: Vol 11 No 6 (view)


    How to cite:
    1.
    Veliawan Z, Rizal A, Prasetya I, Prastya A. Catastrophic implantable cardioverter-defibrillator misclassification of ventricular tachycardia. EJCRIM 2024;11 doi:10.12890/2024_004526.