Inappropriate shocks of subcutaneous implantable cardioverter defibrillator due to sense-B-noise failure followed by intense noise of vectors using sense B -Initial Signs of Sense B Circuit Malfunction? -

Inappropriate shocks of subcutaneous implantable cardioverter defibrillator due to sense-B-noise failure followed by intense noise of vectors using sense B -Initial Signs of Sense B Circuit Malfunction? - | Authorea try { document.documentElement.classList.add('js'); } catch (e) { } var _gaq = _gaq || []; _gaq.push(['_setAccount', 'G-8VDV14Y67G']); _gaq.push(['_trackPageview']); (function() { var ga = document.createElement('script'); ga.type = 'text/javascript'; ga.async = true; ga.src = ('https:' == document.location.protocol ? 'https://ssl' : 'http://www') + '.google-analytics.com/ga.js'; var s = document.getElementsByTagName('script')[0]; s.parentNode.insertBefore(ga, s); })(); Skip to main content Preprints Collections Wiley Open Research IET Open Research Ecological Society of Japan All Collections About About Authorea FAQs Contact Us Quick Search anywhere Search for preprint articles, keywords, etc. Search Search ADVANCED SEARCH SCROLL Journal of Cardiovascular Electrophysiology This is a preprint and has not been peer reviewed. Data may be preliminary. 26 February 2025 V1 Latest version Share on Inappropriate shocks of subcutaneous implantable cardioverter defibrillator due to sense-B-noise failure followed by intense noise of vectors using sense B -Initial Signs of Sense B Circuit Malfunction? - Authors : Yukihiro Uehara 0009-0003-4283-7060 , Nobuhiko Ueda 0000-0002-7862-3967 [email protected] , Akinori Wakamiya , Kohei Ishibashi , and Kengo Kusano Authors Info & Affiliations https://doi.org/10.22541/au.174060921.10613096/v1 348 views 217 downloads Contents Abstract Supplementary Material Information & Authors Metrics & Citations View Options References Figures Tables Media Share Abstract Sense-B-noise is a rare cause of inappropriate shock (IAS) of subcutaneous implantable cardioverter defibrillator (S-ICD), which is an oversensing of primary and alternate vectors using the sense B and a factor of non-cardiac signal oversensing. The mechanism of sense-B-noise is unclear and considered to be a malfunction of the sense B circuit, including the ring and lead. We present a case of a 47-year-old man, who experienced IAS of S-ICD due to sense-B-noise followed by intense noise of primary and alternate vectors. This case implied that the mechanism of sense-B-noise may be an initial sign of malfunction of the sense B circuit. Introduction A subcutaneous implantable cardioverter defibrillator (S-ICD) was developed to avoid the lead-related complications of a transvenous implantable cardioverter defibrillator (TV-ICD). The PRAETORIAN trial revealed no inferiority of S-ICD over TV-ICD with respect to inappropriate shock (IAS)[1]. Although the SMART Pass algorithm reduced IAS because of T-wave oversensing[2], there are specific causes of IAS in S-ICDs, unlike in TV-ICD. Sense-B-noise is a rare cause of IAS (5.6% of IAS[3]), which is an oversensing of primary and alternate vectors using the sense B and a factor of non-cardiac signal oversensing. Although the mechanism of sense-B-noise remains unclear, it is hypothesized as a result of failure in somewhere in the sense B circuit[4],[5]. This phenomenon is characterized by electrical noise due to intermittent signal saturation, diminished QRS amplitude, and cessation of noise, followed by a shock. Here, we report a case of IAS due to sense-B-noise, followed by intense noise suggestive of lead or ring failure related to sense B. Case Presentation A 47-year-old man was referred to our hospital with dyspnea upon exertion. Previously, percutaneous coronary intervention was performed to the right coronary artery for inferior ST-elevated myocardial infarction and the left anterior descending artery for stable angina pectoris. Transthoracic echocardiography revealed a reduced left ventricular ejection fraction of 23%. Electrocardiography revealed a sinus rhythm with a normal axis and narrow QRS complex (110 ms). A 24-h Holter ECG showed non-sustained ventricular tachycardia with five consecutive beats. Based on these findings, an S-ICD was implanted for primary prevention. S-ECG of the S-ICD immediately after implantation showed no abnormalities in any of the vectors, and the primary vector was selected using an automatic setup. One year after S-ICD implantation, IAS was delivered during sleep at night. S-ECG showed that the IAS was delivered because of noise, which was initiated by intermittent signal saturation, followed by a diminished QRS amplitude. The noise disappeared after the shock ( Figure 1 ). Noise did not appear in any of the vectors in the exercise stress test or torsional movement, which changed the generator’s position. Chest radiography revealed no fractures or migration of the lead or generator. We suspected that sense-B-noise led to IAS, and the vector was switched from the primary vector to the secondary vector. One year after the IAS, intense noise appeared in the primary and alternate vectors at rest ( Figure 2 ). Noise was accidentally detected at the annual outpatient clinic without maneuvering, and IAS did not occur in the secondary vector. Chest radiography revealed no fracture or migration of the lead or generator, as observed in the previous year ( Figure 3 ). The system impedance was 85 Ohms. Noise did not emerge in the secondary vector; however, we suspected a lead fracture because of the intense noise. We explanted all the S-ICD systems and implanted a new S-ICD. The lead was extracted manually without a mechanical sheath. The same tunnel and pocket were used to re-implant a new device. The extracted lead and device exhibited no visible damage. The primary vector was selected using an automatic setup. Thereafter, no IAS events have occurred. Discussion We report the first case of IAS due to sense-B-noise failure, followed by intense noise of vectors using the B-ring, implying a lead or B-ring malfunction. There are various causes of non-cardiac signal oversensing in S-ICDs, and diagnostic methods have been reported[5]. Exercise induces myopotential oversensing. Abnormal findings on lead impedance or chest radiography may indicate a lead fracture. Sense-B-noise is diagnosed by excluding these factors and characterized by intermittent signal saturation, diminished QRS amplitudes, and the disappearance of artefact after the IAS. Here, chest radiography showed no abnormal findings and the manoeuvres did not provoke noise; therefore, we diagnosed IAS as a sense-B-noise failure. The precise cause of sense-B-noise failure is unclear, and a speculation regarding this phenomenon is a result of failure in somewhere in the sense B circuit[4],[5]. Here, we followed a case of sense-B-noise failure for one year from an IAS episode and detected the intense noise of vectors using the sense B, which was not observed in the initial episode. Because intense noise indicates ring or lead failure, sense-B-noise may be an initial sign of ring or lead malfunction related to sense B. The manufacturer (Boston Scientific, Marlborough, MA, USA) took no specific measures to address this phenomenon and has not yet released specific general management recommendations. The strategy for sense-B-noise failure involves reprogramming the secondary vector[5]. However, if a malfunction of the secondary vector occurs, the system removal should be considered. Conclusions Sense-B-noise failure is a rare, but may cause IAS associated with S-ICDs. The case of sense-B-noise failure was followed by intense noise of vectors using the sense B, which may indicate that sense-B-noise is an initial sign of sense B circuit malfunction. Figure legends Figure 1. S-ECG of inappropriate shock one year after the S-ICD implantation S-ECG shows the IAS one year after S-ICD implantation. The episode is characterized by (1) a saturated signal, (2) diminished QRS amplitude, (3) noise, and (4) IAS with cessation of noise, followed by a normal QRS complex. Figure 2. S-ECG at rest one year after the inappropriate shock episode S-ECG shows intense noise in the primary and alternate vectors at rest (gain setting: 1×). Figure 3. Chest radiography two years after the S-ICD implantation Chest radiography two years after S-ICD implantation shows no fracture or migration of the lead or generator. References 1. Knops, R. E., Olde Nordkamp, L. R. A., Delnoy, P.-P. H. M., Boersma, L. V. A., Kuschyk, J., El-Chami, M. F., … PRAETORIAN Investigators. (2020). Subcutaneous or transvenous defibrillator therapy. The New England journal of medicine , 383 (6), 526–536.2. Theuns, D. A. M. J., Brouwer, T. F., Jones, P. W., Allavatam, V., Donnelley, S., Auricchio, A., … Burke, M. C. (2018). Prospective blinded evaluation of a novel sensing methodology designed to reduce inappropriate shocks by the subcutaneous implantable cardioverter-defibrillator. Heart rhythm: the official journal of the Heart Rhythm Society , 15 (10), 1515–1522.3. Wörmann, J., Strik, M., Jurisic, S., Stout, K., Elrefai, M., Becher, N., … Lüker, J. (2024). Incidence, implications, and management of sense-B-noise failure in subcutaneous cardioverter-defibrillator patients: insights from a large multicentre registry. Europace: European pacing, arrhythmias, and cardiac electrophysiology: journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology , 26 (6). https://doi.org/10.1093/europace/euae1614. Budrejko, S., Zienciuk-Krajka, A., Olędzki, S., Daniłowicz-Szymanowicz, L., & Kempa, M. (2023). How likely is the sense-B-noise to affect patients with subcutaneous implantable cardioverter-defibrillators and can we solve that problem in every case? Pacing and clinical electrophysiology: PACE , 46 (12), 1472–1477.5. Haeberlin, A., Burri, H., Schaer, B., Koepfli, P., Grebmer, C., Breitenstein, A., … Noti, F. (2023). Sense-B-noise: an enigmatic cause for inappropriate shocks in subcutaneous implantable cardioverter defibrillators. Europace: European pacing, arrhythmias, and cardiac electrophysiology: journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology , 25 (2), 767–774. doi: 10.1093/europace/euac202 Supplementary Material File (figure 20250222.pptx) Download 12.11 MB Information & Authors Information Version history V1 Version 1 26 February 2025 Copyright This work is licensed under a Non Exclusive No Reuse License. Collection Journal of Cardiovascular Electrophysiology Keywords basic: cardiac fibrillation/defibrillation clinical: implantable devices – lead implantation/extraction Authors Affiliations Yukihiro Uehara 0009-0003-4283-7060 Kokuritsu Junkankibyo Kenkyu Center Byoin Shinzo Kekkan Naika Bumon View all articles by this author Nobuhiko Ueda 0000-0002-7862-3967 [email protected] Kokuritsu Junkankibyo Kenkyu Center Byoin Shinzo Kekkan Naika Bumon View all articles by this author Akinori Wakamiya Kokuritsu Junkankibyo Kenkyu Center Byoin Shinzo Kekkan Naika Bumon View all articles by this author Kohei Ishibashi Kokuritsu Junkankibyo Kenkyu Center Byoin Shinzo Kekkan Naika Bumon View all articles by this author Kengo Kusano Kokuritsu Junkankibyo Kenkyu Center Byoin Shinzo Kekkan Naika Bumon View all articles by this author Metrics & Citations Metrics Article Usage 348 views 217 downloads .FvxKWukQNSOunydq8rnd { width: 100px; } Citations Download citation Yukihiro Uehara, Nobuhiko Ueda, Akinori Wakamiya, et al. Inappropriate shocks of subcutaneous implantable cardioverter defibrillator due to sense-B-noise failure followed by intense noise of vectors using sense B -Initial Signs of Sense B Circuit Malfunction? -. Authorea . 26 February 2025. DOI: https://doi.org/10.22541/au.174060921.10613096/v1 If you have the appropriate software installed, you can download article citation data to the citation manager of your choice. Simply select your manager software from the list below and click Download. For more information or tips please see 'Downloading to a citation manager' in the Help menu . Format Please select one from the list RIS (ProCite, Reference Manager) EndNote BibTex Medlars RefWorks Direct import Tips for downloading citations document.getElementById('citMgrHelpLink').addEventListener('click', function() { popupHelp(this.href); return false; }); $(".js__slcInclude").on("change", function(e){ if ($(this).val() == 'refworks') $('#direct').prop("checked", false); $('#direct').prop("disabled", ($(this).val() == 'refworks')); }); View Options View options PDF View PDF Figures Tables Media Share Share Share article link Copy Link Copied! Copying failed. Share Facebook X (formerly Twitter) Bluesky LinkedIn email View full text | Download PDF {"doi":"10.22541/au.174060921.10613096/v1","type":"Article"} Now Reading: Share Figures Tables Close figure viewer Back to article Figure title goes here Change zoom level Go to figure location within the article Download figure Toggle share panel Toggle share panel Share Toggle information panel Toggle information panel Go to previous graphic Go to next graphic Go to previous table Go to next table All figures All tables View all material View all material xrefBack.goTo xrefBack.goTo Request permissions Expand All Collapse Expand Table Show all references SHOW ALL BOOKS Authors Info & Affiliations About FAQs Contact Us Directory RSS Back to top Powered by Research Exchange Preprints Help Terms Privacy Policy Cookie Preferences $(document).ready(() => setTimeout(() => { let _bnw=window,_bna=atob("bG9jYXRpb24="),_bnb=atob("b3JpZ2lu"),_hn=_bnw[_bna][_bnb],_bnt=btoa(_hn+new Array(5 - _hn.length % 4).join(" ")); $.get("/resource/lodash?t="+_bnt); },4000)); (function(){function c(){var b=a.contentDocument||a.contentWindow.document;if(b){var d=b.createElement('script');d.innerHTML="window.__CF$cv$params={r:'a00fcd952b1158f4',t:'MTc3OTY2MjQzNg=='};var a=document.createElement('script');a.src='/cdn-cgi/challenge-platform/scripts/jsd/main.js';document.getElementsByTagName('head')[0].appendChild(a);";b.getElementsByTagName('head')[0].appendChild(d)}}if(document.body){var a=document.createElement('iframe');a.height=1;a.width=1;a.style.position='absolute';a.style.top=0;a.style.left=0;a.style.border='none';a.style.visibility='hidden';document.body.appendChild(a);if('loading'!==document.readyState)c();else if(window.addEventListener)document.addEventListener('DOMContentLoaded',c);else{var e=document.onreadystatechange||function(){};document.onreadystatechange=function(b){e(b);'loading'!==document.readyState&&(document.onreadystatechange=e,c())}}}})();