Ventricular oversensing due to manufacturer-related differences in implantable cardioverter-defibrillator signal processing and sensing lead properties

Ventricular oversensing remains a significant problem in modern implantable cardioverter-defibrillator (ICD) systems. The role of manufacturer-related differences in device-based signal processing on the one hand and sensing lead properties on the other is largely unknown. This retrospective study aimed to evaluate and compare the incidence and mechanisms of ventricular oversensing in single- or dual-chamber ICD systems from Biotronik (BTK), Guidant (GDT), and Medtronic (MDT).

In 245 consecutive patients, device function, stored episodes, and lead parameters were evaluated at implant and during 243 ± 18 days of follow-up. Oversensing occurred in 3.3% of the patients [four T-wave oversensing (TWO), three R-wave double-sensing, and one diaphragmatic myopotentials]. The incidence of ventricular oversensing was generally low if an ICD device and an ICD lead were from one identical manufacturer (BTK: 2/68, GDT: 1/80, and MDT: 1/69; P = 0.67). In the subgroup of ICDs connected to leads from other manufacturers, however, ventricular oversensing was observed in none of 19 GDT and MDT ICDs but in 4 of 9 BTK devices (44.4%, P = 0.012). These four cases of oversensing (three R-wave double-sensing and one TWO) all occurred in BTK ICDs connected to integrated bipolar ICD leads from other manufacturers.

Significant manufacturer-related differences exist in the incidence of ventricular oversensing in single- and dual-chamber ICD systems. Biotronik devices connected to integrated bipolar ICD leads from other manufacturers have an increased risk for R-wave double-sensing.