Clinical and electrocardiographic predictors of T wave oversensing in patients with subcutaneous ICD

• Main Authors: Mikhael F. El-Chami, MD, Bernard Harbieh, MD, Mathew Levy, BS, Angel R. Leon, MD, Faisal M. Merchant, MD
• Format: Article
• Language: English
• Published: Wiley 2016-06-01
• Series: Journal of Arrhythmia
• Subjects: Subcutaneous ICD; T wave oversensing; Inappropriate shocks
• Online Access: http://www.sciencedirect.com/science/article/pii/S1880427616000090

Background: T wave oversensing (TWOS) is a major drawback of the subcutaneous implantable cardioverter defibrillator (S-ICD). Data on predictors of TWOS in S-ICD recipients are limited. We sought to investigate predictors of TWOS in a cohort of patients receiving an S-ICD at our institution. Methods: S-ICD recipients at our center were identified retrospectively and stratified based on the presence or absence of TWOS. Clinical and electrocardiographic parameters were collected and compared between the 2 groups. Results: Ninety-two patients underwent an S-ICD implantation at our institution between April 2010 and January 2015. Six (6.5%) patients had TWOS. These patients were younger (38.1±13.7 vs. 52.3±16.1 years, p=0.04) and had higher left ventricle ejection fractions (48.5±14.9% vs. 28.4±12.2%, p<0.01) than patients without a history of TWOS. Baseline 12-lead electrocardiogram (ECG) parameters were not different between the 2 groups. Leads I, II, and avF (which mimic the sensing vectors of the S-ICD) were further inspected to identify ECG characteristics that could predict TWOS. The QRS amplitude in ECG lead I was significantly smaller in the TWOS group than in the non-TWOS group (3.7 vs. 7.4 mV, p=0.02). Conclusion: In this study, younger age, higher ejection fraction, and lower QRS amplitude were associated with TWOS. These findings could help identify patients referred for S-ICD at high-risk of TWOS.