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Appropriate Implantable Cardioverter-Defibrillator Therapy in Patients with Ventricular Arrhythmia of Unclear Cause in Secondary Prevention of Sudden Cardiac Death
 
 
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Volume 13
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10.3390/jcm13010129
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Article

Safety and Performance of the Subcutaneous Implantable Cardioverter Defibrillator Detection Algorithm INSIGHTTM in Pacemaker Patients

by
Kay F. Weipert
1,*,
Srdjan Kostic
2,
Timur Gökyildirim
3,
Victoria Johnson
4,
Ritvan Chasan
1,
Christopher Gemein
5,
Josef Rosenbauer
1,
Damir Erkapic
1 and
Jörn Schmitt
6
1
Department of Cardiology, Rhythmology and Angiology, Medizinische Klinik II, Diakonie Klinikum Jung Stilling, 57074 Siegen, Germany
2
Department of Cardiology, Kantonsspital Aarau, 5001 Aarau, Switzerland
3
Department of Cardiology, Lahn-Dill Kliniken, 35578 Wetzlar, Germany
4
Department of Cardiology and Angiology, Medizinische Klinik I, Universitätsklinikum Gießen und Marburg, 35392 Giessen, Germany
5
Department of Cardiology, Nephrology, Pneumology and Rhythmology, Klinikum Aschaffenburg-Alzenau, 63739 Aschaffenburg, Germany
6
Department of Cardiology, Pneumology and Angiology, Medizinische Klinik II, Westpfalz-Klinikum, 67655 Kaiserslautern, Germany
*
Author to whom correspondence should be addressed.
J. Clin. Med. 2024, 13(1), 129; https://doi.org/10.3390/jcm13010129
Submission received: 16 November 2023 / Revised: 17 December 2023 / Accepted: 18 December 2023 / Published: 26 December 2023
(This article belongs to the Special Issue Clinical Advances in Ventricular Arrhythmia and Cardiac Arrest)
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Abstract

Background: The use of the S-ICD is limited by its inability to provide backup pacing. Combined use of the S-ICD with a pacemaker may be a good choice in certain situations, yet current experience concerning the compatibility is limited. The goal of this study was to determine the safety and efficacy of the S-ICD in patients with a pacemaker. Methods: A total of 74 consecutive patients with a bipolar pacemaker were prospectively enrolled. First, surface rhythm strips were recorded in all possible pacemaker stimulation modes, to screen for T-wave oversensing (TWOS). Second, a S-ICD functional dummy was placed epicutaneously on the patient in the typical implant position. The same standardized pacing protocol was used as mentioned above, and every stimulation mode was recorded via S-ECG in all vectors. Results: In 16 patients (21.6%), programmed stimulation would have led to VT/VF detection. Triggered episodes were due to counting of the pacing spike(s), QRS complex, premature ventricular contractions, and/or additional TWOS. Three cases triggered in the bipolar stimulation mode. Oversensing was associated with lung emphysema and a reduced QRS amplitude in the S-ECG. Conclusion: The combination of an S-ICD and a pacemaker may lead to inadequate shock delivery due to oversensing, even under programmed bipolar stimulation. Oversensing cannot be sufficiently predicted by the screening tool in pacemaker patients. Testing with an epicutaneous S-ICD dummy in all vectors and stimulation settings is recommended in patients with pre-existing pacemakers.
Keywords: subcutaneous internal cardioverter-defibrillator; pacemaker; oversensing; detection algorithm; inappropriate therapy subcutaneous internal cardioverter-defibrillator; pacemaker; oversensing; detection algorithm; inappropriate therapy

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MDPI and ACS Style

Weipert, K.F.; Kostic, S.; Gökyildirim, T.; Johnson, V.; Chasan, R.; Gemein, C.; Rosenbauer, J.; Erkapic, D.; Schmitt, J. Safety and Performance of the Subcutaneous Implantable Cardioverter Defibrillator Detection Algorithm INSIGHTTM in Pacemaker Patients. J. Clin. Med. 2024, 13, 129. https://doi.org/10.3390/jcm13010129

AMA Style

Weipert KF, Kostic S, Gökyildirim T, Johnson V, Chasan R, Gemein C, Rosenbauer J, Erkapic D, Schmitt J. Safety and Performance of the Subcutaneous Implantable Cardioverter Defibrillator Detection Algorithm INSIGHTTM in Pacemaker Patients. Journal of Clinical Medicine. 2024; 13(1):129. https://doi.org/10.3390/jcm13010129

Chicago/Turabian Style

Weipert, Kay F., Srdjan Kostic, Timur Gökyildirim, Victoria Johnson, Ritvan Chasan, Christopher Gemein, Josef Rosenbauer, Damir Erkapic, and Jörn Schmitt. 2024. "Safety and Performance of the Subcutaneous Implantable Cardioverter Defibrillator Detection Algorithm INSIGHTTM in Pacemaker Patients" Journal of Clinical Medicine 13, no. 1: 129. https://doi.org/10.3390/jcm13010129

APA Style

Weipert, K. F., Kostic, S., Gökyildirim, T., Johnson, V., Chasan, R., Gemein, C., Rosenbauer, J., Erkapic, D., & Schmitt, J. (2024). Safety and Performance of the Subcutaneous Implantable Cardioverter Defibrillator Detection Algorithm INSIGHTTM in Pacemaker Patients. Journal of Clinical Medicine, 13(1), 129. https://doi.org/10.3390/jcm13010129

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