ICD & Resynchronization therapy

Case 1

Reference : The EHRA book of Pacemaker, ICD and CRT Troubleshooting – Hasan Burri, Jean-Claude Deharo

What is the arythmia & how do you manage this ?

If you look closely at the morphology discrimination, the ICD clip the EGM of the tachycardia but still the morphology of the tachycardia is the same than in the stored one

This is aan inappropriate shock -> We need to modify morphology discrimination algorithm settings

Case 2

Reference : The EHRA book of Pacemaker, ICD and CRT Troubleshooting – Hasan Burri, Jean-Claude Deharo

This is Device setting scatter plot of the arythmia is it a VT or a SVT ?

SVT, the problem is that the arythmia is so rapid that it is difficult to add something else to avoid an unnecessary shock

Case 3

Reference : The EHRA book of Pacemaker, ICD and CRT Troubleshooting – Hasan Burri, Jean-Claude Deharo

What do you see ?

Dual tachycardia

AF & VT

Case 4

Reference : The EHRA book of Pacemaker, ICD and CRT Troubleshooting – Hasan Burri, Jean-Claude Deharo

What do you see ?

If you didn’t find the answer go the next case, it the same patient but after the replacement of the box

Case 5

Reference : The EHRA book of Pacemaker, ICD and CRT Troubleshooting – Hasan Burri, Jean-Claude Deharo

What do you see ?

Artefacts in the Near and Far Field due to lead fracture synchronous w systole may be intra cardiac lead fracture

Case 6

Reference : The EHRA book of Pacemaker, ICD and CRT Troubleshooting – Hasan Burri, Jean-Claude Deharo

What do you see ?

TWOS : T Wave Oversensing

Case 7

Reference : The EHRA book of Pacemaker, ICD and CRT Troubleshooting – Hasan Burri, Jean-Claude Deharo

What do you see ?

Atrial oversensing in the RV shock lead

Case 7