Abstract
SummaryThe wearable cardioverter defibrillator (WCD) is a temporary treatment option for patients with potentially reversible risk of sudden cardiac death. This case demonstrates a pitfall during WCD usage in a pacemaker-dependent patient as well as a possible solution allowing continuation of WCD therapy. Bipolar stimulation may lead to double counting of the WCD detection algorithm resulting in false alarm or inappropriate therapy.
Highlights
A 52-year-old man was referred to our institution with progressive dyspoea on exertion (New York Health Association NYHA class III)
The family history was negative for cardiovascular diseases, sudden cardiac death and syncope
The wearable cardioverter defibrillator (WCD) was programmed to a ventricular tachycardia (VT) detection zone at 200 bpm and the ventricular fibrillation (VF) detection zone to 250 bpm before the patient was discharged from hospital 2 weeks after admission with an ejection fraction (EF) of 20% and in NYHA class II
Summary
During follow-up, the patient was pacemakerdependent (right ventricular pacing 100%, no intrinsic QRS complexes at an intervention rate of 30/min) and since echocardiography had shown a newly detected Austria martin.manninger-wuenscher@medunigraz.at severely reduced ejection fraction, the patient was referred to our institution for coronary angiography and endomyocardial biopsy. Recordings from the LifeVest Network showed oversensing of sinus tachycardia with large P waves and broad QRS complexes due to ventricular stimulation between 90 and 110 bpm during all alarm episodes (VAT mode, bipolar pacing at 3.0 V/0.4 ms at a threshold of 0.375 V/0.4 ms) (Fig. 1).
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