T-Wave Oversensing with Contemporary Implantable Cardioverter-Defibrillators

Marc Strik; Sylvain Ploux; Romain Eschalier; Pierre Mondoly; Leslie Fontagne; F Daniel Ramirez; Michel Haïssaguerre; Pierre Bordachar

doi:10.3390/jcdd10100430

T-Wave Oversensing with Contemporary Implantable Cardioverter-Defibrillators

J Cardiovasc Dev Dis. 2023 Oct 17;10(10):430. doi: 10.3390/jcdd10100430.

Authors

Marc Strik^{1

2}, Sylvain Ploux^{1

2}, Romain Eschalier³, Pierre Mondoly⁴, Leslie Fontagne², F Daniel Ramirez⁵, Michel Haïssaguerre^{1

2}, Pierre Bordachar^{1

2}

Affiliations

¹ Bordeaux University Hospital (CHU), Cardio-Thoracic Unit, F-33600 Bordeaux, France.
² IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Université de Bordeaux, F-33600 Bordeaux, France.
³ Department of Cardiology, University Hospital Clermont-Ferrand, 63000 Clermont-Ferrand, France.
⁴ Department of Cardiology, University Hospital Rangueil, 31400 Toulouse, France.
⁵ Division of Cardiology, University of Ottawa Heart Institute, Ottawa, ON K1Y 4W7, Canada.

Abstract

Background: Implantable cardioverter-defibrillators (ICDs) need to reliably detect ventricular tachycardia (VT) and ventricular fibrillation (VF) while avoiding T-wave oversensing (TWOS), which is associated with a risk of inappropriate therapies. The incidence of TWOS with endovascular ICDs appears to differ between manufacturers.

Objectives: We aimed to evaluate the incidence and clinical consequences of TWOS with contemporary Medtronic and Boston Scientific ICDs.

Methods: Consecutive patients implanted with a recent Medtronic or Boston Scientific ICD and remotely monitored at three French centers were included. All transmitted EGMs labelled as VF, VT, non-sustained VT (NSVT), or ventricular oversensing (Medtronic) were screened for TWOS.

Results: Among 7589 transmitted episodes from 674 patients with a Boston Scientific ICD, we did not identify a single case of TWOS. Among 16,790 transmitted episodes from 1733 patients with a Medtronic ICD, we identified 60 patients (3.4%) with at least one episode of TWOS. In 46 patients, TWOS was intermittent (NSVT episodes). In the remaining 14 patients, TWOS resulted in 60 sustained episodes (completed counters). No inappropriate therapies were delivered in 12 of these patients because no therapies were programmed (in monitor zones, 11 episodes) or because therapies were inhibited by the morphology discriminator (Wavelet, 19 episodes) or by the anti-TWOS algorithm (26 episodes). Two patients received inappropriate therapies due to TWOS (0.1% of patients with Medtronic ICDs).

Conclusion: On review of 24,379 transmitted episodes from 2407 patients with endovascular ICDs, we found no case of TWOS with Boston Scientific devices, whereas TWOS was not uncommon with Medtronic devices. However, the risk of inappropriate therapy with Medtronic ICDs was very low (0.1%) due to the often intermittent nature of this phenomenon, the morphology discriminator, and the anti-TWOS algorithm.

Keywords: T-wave; algorithm; implantable cardioverter–defibrillator; oversensing; remote monitoring.

Grants and funding

This work received financial support from the French Government as part of the “Investments of the Future” program managed by the National Research Agency (ANR) (Grant number ANR-10-IAHU-04).