Automatic identification of implantable cardioverter-defibrillator lead problems using intracardiac electrograms

Gunderson, Bruce D.; Patel, Amisha S.; Bounds, Chad A.

doi:10.1109/cic.2002.1166722

Cited by 17 publications

(18 citation statements)

References 5 publications

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“…6 Because oversensing associated with lead fracture typically is transient, 1,7 increasing the NID may reduce inappropriate shocks caused by lead fractures, but it also may increase the risk of syncope before appropriate shocks. 8 In October 2007, Medtronic (Minneapolis, Minn) discontinued sale of Sprint Fidelis leads because of the rate of pace-sense conductor fractures.…”

Section: Editorial P 2117 Clinical Perspective P 2129mentioning

confidence: 99%

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Downloadable Algorithm to Reduce Inappropriate Shocks Caused by Fractures of Implantable Cardioverter-Defibrillator Leads

et al. 2008

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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.

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Section: Editorial P 2117 Clinical Perspective P 2129mentioning

confidence: 99%

“…Although the LIA does not analyze electrograms, electrogram evidence of intermittent, high-frequency noise 7 generally is accepted as an indication for surgical intervention. The downloaded LIA will store electrograms for transient episodes of suspected, rapid oversensing to facilitate interpretation of alerts.…”

Section: Clinical Approach After Lia Alertmentioning

confidence: 99%

Downloadable Algorithm to Reduce Inappropriate Shocks Caused by Fractures of Implantable Cardioverter-Defibrillator Leads

et al. 2008

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“…The LIA in newer ICDs was modified to require an abrupt increase for activation of the impedance trigger, which reduced the number of false-positive alerts. 27 Nevertheless, diagnostic steps 5,12,13 should be performed before surgery to exclude a false-positive alert. These include review of electrograms with single, short intervals after LIA triggers ( Figure 4B and 4C) that provide previously unavailable recordings of transient oversensing.…”

Section: Clinical Approach After Lia Warningmentioning

confidence: 99%

“…Lead-related oversensing was diagnosed by electrograms that showed high-frequency "noise," characteristic of lead fracture. 5,13 We defined 3 secondary end points prospectively. The first was the percentage of patients who received Ն5 inappropriate shocks.…”

Section: End Pointsmentioning

confidence: 99%

Downloadable Software Algorithm Reduces Inappropriate Shocks Caused by Implantable Cardioverter-Defibrillator Lead Fractures

et al. 2010

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Background-Downloadable software upgrades are common in consumer electronics but not in implantable medical devices. Fractures of implantable cardioverter-defibrillator (ICD) leads present commonly as inappropriate shocks. A lead-integrity alert (LIA) designed to reduce inappropriate shocks is the first software download approved to enhance nominally functioning, previously implanted ICDs. Methods and Results-We performed a prospective study to determine whether an LIA could reduce inappropriate shocks.Patients were included if they had ICD lead fractures confirmed by analysis of explanted leads. The LIA group included the first 213 patients who met the inclusion criteria after the LIA was approved who had the LIA downloaded. The LIA is triggered either by high impedance or rapid oversensing. It responds by delaying detection of ventricular fibrillation and initiating a patient alert every 4 hours. The control group included the first 213 patients who did not have the LIA downloaded. They were monitored by conventional daily impedance measurements that respond with a daily alert. The LIA group had a 46% relative reduction (95% confidence interval 34% to 55%) in the percentage of patients with Ն1 inappropriate shock (LIA 38% versus control 70%, PϽ0.001) and a 50% relative reduction (95% confidence interval 33% to 61%) in the percentage with Ն5 shocks (25% versus 50%, PϽ0.001). The LIA group also had a higher percentage of patients who either did not receive a shock or had Ն3 days of warning before the shock (72% versus 50%, PϽ0.001). Conclusions-A software download that upgrades previously implanted ICDs without surgical revision reduces inappropriate shocks caused by lead fractures. (Circulation.

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“…Database. The algorithm discussed earlier was designed based on our prior reported experience with ICD lead failures (12,13). Because the incidence of lead failures is small, very large and lengthy studies would be needed to collect enough patients with lead failures to develop and test the algorithm.…”

Section: Methodsmentioning

confidence: 99%

An algorithm to predict implantable cardioverter-defibrillator lead failure

Gunderson

Patel

Bounds

et al. 2004

Journal of the American College of Cardiology

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Automatic identification of implantable cardioverter-defibrillator lead problems using intracardiac electrograms

Cited by 17 publications

References 5 publications

Downloadable Algorithm to Reduce Inappropriate Shocks Caused by Fractures of Implantable Cardioverter-Defibrillator Leads

Downloadable Algorithm to Reduce Inappropriate Shocks Caused by Fractures of Implantable Cardioverter-Defibrillator Leads

Downloadable Software Algorithm Reduces Inappropriate Shocks Caused by Implantable Cardioverter-Defibrillator Lead Fractures

An algorithm to predict implantable cardioverter-defibrillator lead failure

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