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Europace Advance Access originally published online on June 19, 2008
Europace 2008 10(8):914-917; doi:10.1093/europace/eun167
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2008. For permissions please email: journals.permissions@oxfordjournals.org

Implantable cardioverter-defibrillators

Implantable cardiac defibrillator lead failure or myopotential oversensing? An approach to the diagnosis of noise on lead electrograms

Marcin Kowalski1, Kenneth A. Ellenbogen1,*, Mark A. Wood1 and Peter L. Friedman2

1 Division of Cardiology, Virginia Commonwealth University School of Medicine, Richmond, VA 23298-0053, USA; 2 Cape Cod Hospital, Hyannis, MA, USA

The appearance of noise on electrograms (EGMs) recorded from the lead of an implantable cardioverter-defibrillator (ICD) may be owing to oversensing of myopotentials, insulation breach, conductor coil fracture, loose set screw, or electromagnetic interference from an external source. The extraneous noise may lead to inappropriate shocks or inhibition of pacing. We describe two cases of pectoral myopotentials oversensing in patients with ICD and an approach to distinguish among the various extraneous noises recorded on EGMs. A systematic approach to identify the cause of the noise is important to render an appropriate treatment, which might include simple device re-programming or require re-operation and lead revision or replacement.

Key Words: Implantable cardioverter- defibrillator, Oversensing of myopotentials

* Corresponding author. Tel: +1 804 828 7565; fax: +1 804 828 6082 E-mail address: kellenbogen{at}pol.net

Manuscript submitted 6 April 2008. Accepted after revision 27 May 2008.


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