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KMID : 1011920120130010032
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International Journal of Arrhythmia
2012 Volume.13 No. 1 p.32 ~ p.36
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Inappropriate implantable cardioverter-defibrillator shocks in a patient with hypertrophic cardiomyopathy
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On Young-Keun
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Abstract
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A 47-year-old man presented with hypertrophic cardiomyopathy (HCM) and syncope. He had a family history of sudden cardiac death (father and brother). He had an implantable cardioverter-defibrillator (ICD) for primary prevention of sudden cardiac death. The patient complained of 2 ICD shocks after implantation and electronic analysis revealed that the arrhythmia was atrial fibrillation at a heart rate of 207 bpm. The ICD had been reprogrammed to prevent inappropriate shock, and he was medicated for treatment of the atrial fibrillation. The ICD provides a significant reduction in mortality in survivors of sudden cardiac arrest and high-risk patients with cardiovascular disease. However, inappropriate shocks are painful, psychologically disturbing, potentially arrhythmogenic and could increase mortality. The causes of inappropriate ICD shocks include supraventricular tachycardia, oversensing of P or T waves as R waves, double counting of R waves,
and an artifact from lead fractures or electromagnetic interference. Early detection of asymptomatic AF can facilitate early treatment via ICD reprogramming or medications adjustments to reduce the risk of inappropriate shocks and morbidity.
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KEYWORD
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implantable cardioverter-defibrillator, shocks , hypertrophic cardiomyopathy
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