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Written by bioXplorer
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Oct 07, 2007 at 12:24 PM |
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[European Perspectives] European Perspectives
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[Images in Cardiovascular Medicine] Severe Left Atrial Appendage Stunning After Electrical Cardioversion of Atrial Fibrillation
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[Correspondence] Letter by Behr and Camm Regarding Article, "Induced Brugada-Type Electrocardiogram, a Sign for Imminent Malignant Arrhythmias"
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[Correspondence] Response to Letter Regarding Article, "Induced Brugada-Type Electrocardiogram, a Sign for Imminent Malignant Arrhythmias"
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[Correspondence] Letter by Greyson Regarding Article, "High-Dose Folic Acid Pretreatment Blunts Cardiac Dysfunction During Ischemia Coupled to Maintenance of High-Energy Phosphates and Reduces Postreperfusion Injury"
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[Correspondence] Response to Letter Regarding Article, "High-Dose Folic Acid Pretreatment Blunts Cardiac Dysfunction During Ischemia Coupled to Maintenance of High-Energy Phosphates and Reduces Postreperfusion Injury"
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[Clinical Summaries] Clinical Summaries
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[Editorials] A Better Method for Preventing Adverse Clinical Events Caused by Implantable Cardioverter-Defibrillator Lead Fractures?
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[Editorials] Exercise-Induced Pulmonary Arterial Hypertension: A New Addition to the Spectrum of Pulmonary Vascular Diseases
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[Arrhythmia/Electrophysiology] Downloadable Algorithm to Reduce Inappropriate Shocks Caused by Fractures of Implantable Cardioverter-Defibrillator Leads
Background— The primary method for monitoring implantable cardioverter-defibrillator lead integrity is periodic measurement of impedance. Sprint Fidelis leads are prone to pace-sense lead fractures, which commonly present as inappropriate shocks caused by oversensing. Methods and Results— We developed and tested an algorithm to enhance early identification of lead fractures and to reduce inappropriate shocks. This lead-integrity algorithm, which can be downloaded into presently implanted implantable cardioverter-defibrillators, alerts the patient and/or physician when triggered by either oversensing or excessive increases in impedance. To reduce inappropriate shocks, the lead-integrity algorithm increases the number of intervals to detect (NID) ventricular fibrillation when triggered. The lead-integrity algorithm was tested on data from 15 970 patients with Fidelis leads (including 121 with clinically diagnosed fractures) and 95 other fractured leads confirmed by analysis of returned product. The effect of the NID on inappropriate shocks was tested in 92 patients with 927 shocks caused by lead fracture. Increasing the NID reduced inappropriate shocks (P<0.0001). The lead-integrity algorithm provided at least a 3-day warning of inappropriate shocks in 76% (95% CI, 66 to 84) of patients versus 55% (95% CI, 43 to 64) for optimal impedance monitoring (P=0.007). Its positive predictive value was 72% for lead fractures and 81% for lead fractures or header-connector problems requiring surgical intervention. The false-positive rate was 1 per 372 patient-years of monitoring. Conclusions— A lead-integrity algorithm developed for download into existing implantable cardioverter-defibrillators increases short-term warning of inappropriate shocks in patients with lead fractures and reduces the likelihood of inappropriate shocks. It is the first downloadable RAMware to enhance the performance of nominally functioning implantable cardioverter-defibrillators and the first implantable cardioverter-defibrillator monitoring feature that triggers real-time changes in ventricular fibrillation detection parameters to reduce inappropriate shocks.
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Last Updated ( Jul 23, 2008 at 05:05 PM )
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