Use of an electrocardiographic screening tool to determine candidacy for a subcutaneous implantable cardioverter-defibrillator

Christopher A. Groh, Shishir Sharma, Daniel J. Pelchovitz, Prashant D. Bhave, John Rhyner, Nishant Verma, Rishi Arora, Alexandru B. Chicos, Susan S. Kim, Albert C. Lin, Rod S. Passman, Bradley P. Knight*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

70 Scopus citations

Abstract

Background An electrocardiographic (ECG) screening test has been developed to identify patients being considered for a totally subcutaneous implantable cardioverter-defibrillator (S-ICD) at risk for T-wave oversensing. Objective The purpose of this study was to determine the proportion of potential S-ICD recipients who fail the ECG screening test and to identify predictors of failure. Methods Patients who already have an ICD but are not receiving antibradycardia pacing are representative of patients who might be considered for an S-ICD. One hundred such outpatients were enrolled in the study. Surface rhythm strips were recorded along the sensing vectors of the S-ICD system and the screening template applied. Clinical and standard ECG characteristics of patients who failed the test were compared to those who passed. Results Patients had the following characteristics: 72% male, age 57 ± 16 years, body mass index 29 ± 6 kg/m2, left ventricular ejection fraction 43% ± 17%, QRS duration 109 ± 23 ms, QTc interval 447 ± 39 ms, 44% had coronary disease, and 55% had heart failure. Among the 100 patients, 8% failed the screening test. There were no differences in patient clinical characteristics and most standard ECG measurements. However, patients with T-wave inversions in standard ECG leads I, II, and aVF had a 45% chance of failing. Conclusion Eight percent of potential S-ICD patients were not eligible for the S-ICD after failing the screening test designed to identify patients susceptible to T-wave oversensing. Patients with T-wave inversions in leads I, II, and aVF on a standard ECG were 23 times more likely to fail. More work is needed in S-ICD sensing algorithms to increase patient eligibility for the S-ICD.

Original languageEnglish (US)
Pages (from-to)1361-1366
Number of pages6
JournalHeart rhythm
Volume11
Issue number8
DOIs
StatePublished - Aug 2014

Keywords

  • Defibrillator screening
  • Implantable cardioverter-defibrillator
  • Inappropriate shocks
  • Subcutaneous implantable cardioverter-defibrillator
  • T-wave oversensing

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

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