How Atrial Premature Beats Could Have Contributed to Inappropriate ICD Therapy?

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<B>Case report:</B> A 55-year-old weman was reffered for secondary prevention of sustained ventricular tachycardia (VT). The heart rate of her VT was 220 beats/min. Her treated with an CURRENT DR CD2211-36Q (Sr. Jude Medical) dual chamber implantable cardioverter defibrillator (ICD). The ventricular fibrillation (VF) zone was programmed to deliver shock at a detection threshold of 200 beats/min. The ventricular tachycardia zone was programmed to antitachycardia pacing at a detection threshold of 182 beats/min. An additional VT monitoring zone was programmed to 150 beats/min. At the next day of implantation, she received inappropriate shock. On the interrogation, the ICD shock followed a sinus tachycardia that averaged 133/min and isolated atrial premature beats. How atrial premature beats could have contributed to inappropriate ICD therapy? In this case, atrial premature beat intervals met the VF detection interval while the average interval satisfied the VT monitoring interval. Therefore, these premature beats were binned as VF. When the 12 such isolated atrial premature beats were recorded, the VF detection criterion was satisfied and shock delivered. For the reduction of the risk of inappropriate shock deliverly, we reprogrammed the monitoring zone to turn off. <B>Conclusion:</B> To our knowledge, an inappropriate shock in the sinus tachycardia with isolated atrial premature beats due to binning non-consecutive VF intervals has not been reported.