CARDIOVERTER-DEFIBRILLATOR OVERSENSING DUE TO DOUBLE COUNTING OF VENTRICULAR-TACHYCARDIA ELECTROGRAMS

We report a case of a patient with idiopathic dilated cardiomyopathy a nd recurrent ventricular tachycardias refractory to antiarrhythmic tre atment with amiodarone, A cardioverter defibrillator implantation was performed by the transvenous technique, but ventricular tachycardia de tection resulted to be inappropriate because of constant double sensin g of ventricular tachycardia electrograms (QRS width=250 ms). Device p rogrammability didn't allow a satisfactory solution to this problem, t herefore a more appropriate sensing system was considered. Through an anterior thoracotomy two epicardial wires were positioned acid sensing by these wires, placed closer to ventricular tachycardia origin, resu lted appropriate. An electrophysiologic study and subsequent follow up confirmed appropriate ICD detection of ventricular tachycardias. This case emphasizes how in some cases sensing by epicardial wires may be a solution for QRS double counting occurring with endocardial leads du ring ventricular tachycardia. (C) 1998 Elsevier Science Ireland Ltd. A ll rights reserved.