Incidence of Inappropriate Subcutaneous Implantable Cardioverter Defibrillator Discharges Related to Electromagnetic Interferences

Abstract

Background: The subcutaneous implantable cardioverter-defibrillator (S-ICD) was approved for the prevention of sudden cardiac death among candidates to a transvenous implantable cardioverter-defibrillator (T- ICD) without indication for cardiac resynchronization therapy (CRT), recurrent monomorphic ventricular tachycardia (VT), or pre-existing unipolar pacemaker leads, or anti-bradycardia pacing. In the available S-ICD trials, the inappropriate shock (IAS) rate was reported to be between 5% to 25% and was mainly due to cardiac and extra cardiac over sensing.
Objective: The purpose of this study is to provide the rate of IAS related to electromagnetic interference (EMI) in patients with second- and third-generation of S-ICD. Consequently, we suggest recommendations that promote evidence-based best practices to avoid IAS in the Emergency Department.
Methods: Literature between January 2013 and May 2020 on IAS and S-ICD was identified by database search. We included studies assessing IAS rates due to electromagnetic over sensing. We identified 4 clinical studies and 28 case reports.
Results: The total population included 2286 patients. Of these, 54 patients received IAS due to extracardiac over sensing related to EMI (2.36%).
Conclusion: Extracardiac IAS related to EMI is detectable also in patients with second- and third-generation of S-ICD. In the Emergency Department in all the case of IAS related to EMI, in the absence of a suitable programmer, using a magnet is the first step to deactivate shocks and to avoid the painful and depletion of battery life.