T-Wave Oversensing in Patients with Brugada Syndrome - True Bipolar Versus Integrated Bipolar ICD Leads
Rodríguez-Mañero M(1), de Asmundis C(2), Sacher F(3), Arbelo E(4), Probst V(5), Castro-Hevia J(6), Maury P(7), Rollin A(7), Lambiase P(8), García-Bolao I(9), Chierchia GB(2), Fukushima-Kusano K(10), Gourraud JB(5), Schilling R(8), Kamakura T(10), Martínez-Sande L(11), Haïssaguerre M(3), González-Juanatey JR(11), Brugada J(4), Brugada P(2). (1) Hospital Clínico Universitario de Santiago de Compostela (CHUS), Santiago de Compostela, Spain
(2) Vrije Universiteit Brussel (VUB), Brussels, Belgium.
(3) Bordeaux University Hospital, LIRYC Institute/INSERM 1045, Bordeaux, France.
(4) Hospital Clínic Universitario de Barcelona, Institut du Thorax, Barcelona, Spain.
(5) CHU de Nantes, Nantes, France.
(6) Instituto de Cardiología y Cirugía Cardiovascular, La Habana, Cuba.
(7) CHU de Toulouse, Toulouse, France.
(8) St. Bartholomew's Hospital, London, United Kingdom.
(9) Clinica Universidad de Navarra, Pamplona, Spain.
(10) Department of Cardiovascular Medicine, National Cerebral & Cardiovascular Center, Suita, Osaka, Japan.
(11) Hospital Clínico Universitario de Santiago de Compostela (CHUS), Santiago de Compostela, Spain.
Revisão:Circulation. Arrhythmia and Electrophysiology
It is thought that compared to integrated bipolar leads, dedicated bipolar are more susceptible to T-wave oversensing. This could be of extreme importance in patients with Brugada syndrome (BrS) since T-wave oversensing in this population is more frequent compared to other ICD recipients without BrS. We aimed to compare the incidence of T-wave oversensing in patients with BrS according to the type of lead (integrated bipolar versus true/dedicated bipolar).
METHODS AND RESULTS:
All BrS patients with an ICD implant in 10 tertiary hospitals between 1993 and 2013. A total of 480 patients were included (mean age 45,6 ± 14). During a mean follow-up of 74,9 ± 51,7 months (median 69, range 2-236), 28 patients had T-wave oversensing (5,8%), leading to inappropriate shock in 18 (3,8%). All these events occurred in patients with true bipolar ICD leads (p=0,01) and in two patients it was solved instantaneously by changing the configuration from a dedicated to an integrated bipolar sensing configuration. In the stepwise multivariate models only integrated bipolar ICD leads (HR 0.34; 95% CI 0,171-0,675; p=0,002) was independent predictor of non T-wave oversensing.
T-wave oversensing is a potential reason of inappropriate shocks in patients with BrS receiving ICDs. In the vast majority it can be solved by reprogramming. However, in some patients it still requires invasive intervention. Importantly, incidence is significantly lower using an integrated bipolar lead system when compared to a dedicated bipolar lead system and hence the latter should be routinely employed in BrS cases.
CITAÇÃO DO ARTIGO Circ Arrhythm Electrophysiol. 2015 Jun 3. pii: CIRCEP.115.002871.
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