Abstract 16438: Elimination of Inappropriate Subcutaneous ICD Shocks by Using a Non-Absorbable Pouch When Non-Invasive Reprogramming Fails

Introduction: Subcutaneous ICD (S-ICD) sensing algorithms and program options differ from conventional ICDs. A nominal physical shift of the generator can frequently cause change in signal-to-noise ratio and lead to inappropriate shock. Reprogramming may help eliminate some T-wave over-sensing (TWOS), however is not possible in all cases. We present a case of multiple inappropriate shocks due to TWOS from ICD generator shift that was refractory to conventional reprogramming of sensing vectors, but was successfully treated with a novel solution. Clinical Vignette A 33-year old female patient with a known history of non-ischemic cardiomyopathy underwent S-ICD implantation for primary prevention of sudden cardiac death. Three months post-implantation, the patient suffered a total of 8 inappropriate shocks over 3 months due to TWOS; each shock occurred while bending at the waist. Multiple attempts at careful reprogramming of sensing vectors were performed, yet the patient continued to experience 4 more shocks...