Postoperative ergometry‐guided programming does not prevent T‐wave oversensing and inappropriate shocks in S‐ICD patients. Issue 6 (25th April 2018)

• Record Type: Journal Article
• Authors: Larbig, Robert; Motloch, Lukas J.; Bettin, Markus; Fischer, Alicia; Frommeyer, Gerrit; Reinke, Florian; Loeher, Andreas; Eckardt, Lars; Köbe, Julia
• Is Part Of: Pacing and clinical electrophysiology. Volume 41:Issue 6(2018)
• Page Start: 567
• Page End: 571
• Publication Date: 2018-04-25
• Subjects: ergometry -- inappropriate shock -- S‐ICD -- T wave oversensing; Cardiac pacing -- Periodicals; Electrophysiology -- Periodicals; 617.4120645
• DOI: 10.1111/pace.13327
• Languages: English
• ISSNs: 0147-8389

Abstract

Abstract: Background: T‐wave oversensing (TWOS) is a feared complication after subcutaneous implantable cardioverter‐defibrillator (S‐ICD) implantation, potentially leading to inappropriate shocks (IS) with tremendous impact on quality of life. Hypothesis: Postoperative ergometry facilitates primary and secondary prevention of TWOS or other potential causes of IS and optimizes S‐ICD programming. Methods: We analyze the impact of ergometry guided‐programming (EMGP) on primary and secondary prevention of TWOS/IS in S‐ICD patients, we screened 146 patients implanted in our center (2010–2016) for the incidence of TWOS/IS during postoperative ergometry. Furthermore, to evaluate the outcome in 123 eligible patients complete follow‐up (FU) of at least 6 months up to 2 years was retrospectively analyzed. Results: (1) Primary prevention: TWOS could only be provoked postoperatively in 3.7% of patients (n = 3/82). FU analyses did not reveal significant differences compared to our control group (Ctrl: n = 6/61, 9.8% vs EMGP: n = 5/62, 8.1%; P = 0.731). Further subgroup analyses of patients with postoperative ergometry in the close postoperative period (< 7 days; n = 3/45, 6.7%; P = 0.563) did not yield any significant difference. (2) Secondary prevention: We found various causes of TWOS/IS. In patients who underwent reprogramming due to previous TWOS/IS events we observed a 66.7% (n = 6/9) reduction of TWOS/IS using EMGP. Conclusion: TWOS/IS has various causes while not all cases are exercise‐associated. Postoperative ergometry does not seem to be useful for primary prevention. Further trials need to investigate the potential benefit of EMGP for secondary prevention of TWOS/IS.