ArticleEuropace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology2023
Exploiting SMART pass filter deactivation detection to minimize inappropriate subcutaneous implantable cardioverter defibrillator therapies: a real-world single-centre experience and management guide.
Article in Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers.
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11 citing papers in PubMed, 18 citations in OpenAlex.
- Combined Application of a Helix-Fixation Leadless Pacemaker and a Subcutaneous Implantable Cardioverter-Defibrillator in a Dialysis Patient: A Case Report.Clinical case reports · 2026Article
- A case report of an S-ICD-recorded asystole due to SMART pass deactivation in a patient with non-obstructive hypertrophic cardiomyopathy.European heart journal. Case reports · 2026Article
- Midterm Efficacy of SubcutAneous Implantable CardioVErter-Defibrillator in ≤ 18 Year-Old CHILDREN (SAVE CHILDREN-II Registry).Journal of arrhythmia · 2026Article
- Sensing challenges in patients with cardiac amyloidosis and subcutaneous implantable cardioverter-defibrillators.HeartRhythm case reports · 2026Article
- When signals diverge, what MAUDE can and cannot tell us about subcutaneous implantable defibrillator inappropriate shocks.Heart rhythm O2 · 2026Article
- Significance of 3-dimensional cardiac anatomical axis as the predictor of low QRS amplitude of subcutaneous implantable cardioverter-defibrillator.Heart rhythm O2 · 2025Article
- Subcutaneous versus transvenous implantable cardioverter defibrillator in hypertrophic cardiomyopathy: a systematic review and meta-analysis.Cardiovascular diagnosis and therapy · 2024Article
- Intra-Abdominal Hemorrhage Triggering Inappropriate Therapy From a Subcutaneous Defibrillator.JACC. Case reports · 2024Article
- Comparison of automated subcutaneous defibrillator screening between different pacing sites in cardiac pacing device carriers.Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology · 2023Article
- Management of sensing issues with a subcutaneous implantable cardioverter-defibrillator in a patient with Brugada syndrome: A case report.HeartRhythm case reports · 2023Article
- Modern subcutaneous implantable defibrillator therapy in patients with cardiomyopathies and channelopathies: data from a large multicentre registry.Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology · 2023Article
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Authors and funding
11 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
aimsThe SMART Pass™ (SP) algorithm is a high-pass filter that aims to reduce inappropriate therapy (IT) in subcutaneous internal cardiac defibrillator (S-ICD), but SP can deactivate due to low amplitude sensed R waves or asystole. The association between IT and SP deactivation and management strategies were evaluated, hypothesizing SP deactivation increases the risk of IT and device re-programming, or lead/generator re-positioning could reduce this risk. METHODS AND
resultsRetrospective single-centre audit of Emblem™ S-ICD devices implanted 2016 to 2020 utilizing health records and remote monitoring data. Cox regression models evaluated associations between SP deactivation and IT. A total of 348 patients (27 ± 16.6 months follow-up) were studied: 73% primary prevention. Thirty-eight patients (11.8%) received 83 shocks with 27 patients (7.8%) receiving a total of 44 IT. Causes of IT were oversensing (98%) and aberrantly conducted atrial fibrillation (2%). SP deactivation occurred in 32 of 348 patients (9%) and was significantly associated with increased risk of IT (hazard ratio 5.36, 95% CI 2.37-12.13). SP deactivation was due to low amplitude R waves (94%), associated with a higher defibrillation threshold at implant and presence of arrhythmogenic right ventricular cardiomyopathy. No further IT occurred 16 ± 15.5 months after corrective interventions, with changing the sensing vector being successful in 59% of cases.
conclusionTo reduce the risk of IT, the cause of the SP deactivation should be investigated, and appropriate reprogramming, device, or lead modifications made. Utilizing the alert for SP deactivation and electrograms could pro-actively prevent IT.
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