Inappropriate Discharge of an Implantable Cardioverter Defibrillator During Atrial Flutter and Intermittent Ventricular Antibradycardia Pacing


Werner Peters, M.D., Medizinische Klinik der Universiatät Würzburg, Josef-Schneider-Str. 2, 97080 Wurzbrug, Germany. Fax; 49-931-201-2291; E-mail:


Inappropriate Discharge of an ICD. Introduction: Inappropriate discharses of an implantable cardioverter defibrillator (ICD) are troublesome to the patient and sometimes a difficult task for the physician trying; to identify and treat the cause.

Methods and Results: For the first time, we report a mechanism of inappropriate ICD discharges during episodes of atrail flutter with a slow ventricular response and intermittent antibradycardia pacing. The episodes occurred in tow patients and were triggered by the unique sensing alogorithm of the Ventitex Cadence® V-100 in combination with the tripolar CPI Endotak® 072 transvenous defibrillation lead, which provides integrated bipolar sensing.

Conclusion: Besides treatment of the underlying arrhythmia, reprogramming of the device, an electrode position far away from the atria, and true bipolar sensing will enhance the performance of ICD systems with respect to the episodes described here. In addition, more flexible sensing algorithms may. in the future, prevent this overall rare complication.