Effects of Pacing and High-Pass Filter Settings on Ventricular Bipolar Electrograms in Implantable Cardioverter-Defibrillator Systems: Implication for Inappropriate Shocks Due to T Wave Oversensing

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Introduction: The information about the effects of pacing and high-pass filter settings on ventricular bipolar electrograms in implantable cardioverter-defibrillator (ICD) systems is not available. Methods: 13 consecutive patients (male: 12, age: 48±15 y/o) who underwent ICD (Lexos DR and Lumax 340 DR-T, Biotronik) implantation were included. We measured amplitude of bipolar electrograms from ventricular lead during AAI and DDD mode (120 bpm, AV delay: 140 ms), and intravenous isoproterenol (ISO) infusion adjusting HR as 120 bpm with the nine high-pass filter settings (Hz) (high pass I/II: 40–0.625/5–20, low pass: fixed 40). Results: About the R wave amplitude, DDD mode showed significantly lower compared with AAI and ISO (vs AAI: P<0.001, vs ISOP: P<0.001). Furthermore, there is a significant difference in the effects of high-pass filter settings on R wave amplitude among three phase (P<0.001). DDD mode significantly larger number of patients showing T/R ratio (>0.25) compared with other phase (P<0.001), and smaller number of patients showing T/R ratio (<0.25) compared with other phase (P<0.001) (high-pass I/II: 10/20). Conclusions: These findings have important implication for Inappropriate shocks due to T wave oversensing.