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Background: Implantable cardioverter-defibrillator (ICD) ventricular oversensing may result in inappropriate therapy, which may be triggered by lead/connection issues that require surgical revision or physiologic oversensing that may be resolved with reprogramming. The sensing integrity counter (SIC) is an oversensing diagnostic that increments for very rapid ventricular intervals ≤130 ms. Objective: The purpose of this study was to determine the causes of a high SIC and the ability of additional diagnostics to differentiate lead/connection issues from other causes of oversensing for patients with normal impedance. Methods: Frequent SICs were identified in patients during routine follow-up visits. To diagnose the cause of oversensing, patients wore a modified 24-hour digital Holter monitor that recorded ECG, ventricular electrogram, and the ICD Marker Channel (Medtronic). Recordings were reviewed to determine the causes of oversensing. Patients with confirmed oversensing and adequate data were analyzed. The number of SICs per day and the presence of a nonsustained tachycardia (NST) episode with ventricular mean cycle length <220 ms were retrieved from stored ICD data. Results: Forty-eight patients had a median of 13 SICs/day. Presumed lead/connection issues occurred in 23% of patients, whereas physiologic oversensing occurred in 77% of patients. A rapid NST was recorded more commonly in patients with lead/connection issues than in those without (9/11 vs 1/37; P < .0001). Conclusion: Oversensing resulting in frequent, very short intervals typically are caused by either lead/connection issues or physiologic signals. The additional finding of rapid NSTs usually indicates a lead/connection issue, even in the absence of impedance abnormalities. [Copyright &y& Elsevier]

We describe the case of a patient who presented with multiple implantable cardioverter-defibrillator (ICD) shock discharges 12 months after device implantation. Upon device interrogation, intermittent oversensing of electrical noise and potential ICD lead failure were suggested by a significant increase in the sensing integrity counter (SIC), a cumulative count of very short ventricular sensed intervals. Analysis of stored episodes, however, revealed that inappropriate ICD therapy had been caused by intermittent T-wave oversensing (TWO), and that the increase of the SIC resulted from the coincidence of TWO and premature ventricular complexes (PVCs). T-wave oversensing resolved and the SIC did not increase any more during follow-up after adjustment of ventricular sensitivity. The coincidence of TWO and PVCs should therefore be considered as an uncommon cause for short ventricular sensed intervals in ICD patients presenting with a suspect increase in the SIC. [ABSTRACT FROM PUBLISHER]