ACC/AHA/ACCP/HRS Guideline (2023): Diagnosis and Management of Atrial Fibrillation — EECC MCQ

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HardCardiology / EndocrinologyACC/AHA/ACCP/HRS Guideline (2023): Diagnosis and Management of Atrial FibrillationEECC

An ICD delivers repeated inappropriate shocks during sinus tachycardia. Stored electrograms show double counting of each QRS because the T wave is sensed as a second ventricular event. Which corrective strategy is most appropriate first?

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Correct answer: C — Device reprogramming to eliminate T-wave oversensing

The best answer is “Device reprogramming to eliminate T-wave oversensing”. The electrogram proves an oversensing problem, so vector, sensitivity, filtering and detection programming should be corrected before exposing the patient to further shocks. “Increase shock energy while leaving sensing unchanged” is less appropriate because higher energy does not prevent erroneous detection “Add amiodarone before full assessment the device” is less appropriate because antiarrhythmic medication does not fix double counting of T waves “Deactivate all tachyarrhythmia therapy permanently” is less appropriate because permanent deactivation leaves genuine ventricular arrhythmia untreated “Replace the generator principally because shocks occurred” is less appropriate because generator replacement is unnecessary unless a hardware fault is demonstrated

Reference: 2022 ESC Guidelines for ventricular arrhythmias and sudden cardiac death. https://academic.oup.com/eurheartj/article/43/40/3997/6675633