Troubleshooting of small R-wave with inappropriate implantable cardioverter-defibrillator shock

摘要

A 5-year-old girl with catecholaminergic polymorphic ventricular tachycardia received an implantable cardioverter-defibrillator (ICD) in abdominal position after she had survived ventricular fibrillation. A shock lead was placed in the sinus transversus and a bipolar epicardial pace-sense lead was actively fixed to the left ventricle. Over time, the R-wave amplitude decreased from 10.3 mV post-operatively to finally <2 mV 2.5 years later (Panel A), resulting in T-wave oversensing and inaproppriate shock.