When Life‐Saving Devices Terminate Life

Catanchin, Andrei; Anderson, Lisa; Jones, S.; De, Ward

doi:10.1111/j.1540-8167.2007.01080.x

Cited by 22 publications

(23 citation statements)

References 10 publications

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“…Rarely, they cause clinically significant loss of pacing, the inability to defibrillate, or fatal proarrhythmia. 15 Existing methods of identifying these fractures based on impedance monitoring are insufficient. 4,11 Oversensing of nonphysiological signals causes inappropriate shocks in pacesense lead failures independently of the failure mechanism.…”

Section: Detecting Pace-sense Conductor Failuresmentioning

confidence: 99%

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: Detecting Pace-sense Conductor Failuresmentioning

confidence: 99%

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

et al. 2008

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“…[2][3][4][5] Fractures have been reported to cause loss of pacing, failure of defibrillation, or fatal proarrhythmia. 9 To reduce inappropriate shocks, we developed a lead-integrity alert (LIA) triggered by either oversensing or high impedance 5,10 that can be downloaded into previously implanted ICDs.…”

mentioning

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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“…2 But the interventions provided could actually be proarrhythmogenic with some of them causing clinical and hemodynamic 5,6 bradyarrhythmias and tachyarrhythmias. With subsequent addition of pacers, bradyarrhythmias are becoming less common.…”

Section: Discussionmentioning

confidence: 99%

Preface to the fourth issue of Journal of Cardiovascular Disease Research

Dai

2010

Journal of Cardiovascular Disease Research

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Introduction: Automated implantable cardioverter defi brillator (AICD) interventions have the potential to be proarrhythmogenic. This is related to suboptimal programming and technical limitations of the device. We sought to categorize the stored events in Boston Scientifi c Latitude remote monitoring system to appropriate and inappropriate shocks and identify the proarrhythmic event. Methods: Currently patients with an AICD are monitored and stored remotely. We reviewed the Boston Scientifi c Latitude database for stored events and categorized them. Shocks delivered for deleterious arrhythmias (ventricular fi brillation) were considered appropriate. Shocks delivered for relatively benign arrhythmias (ex-sinus tachycardia treated with anti-tachycardic pacing) were considered inappropriate. Worsening of baseline arrhythmia secondary to implantable cardioverter-defi brillator treatment is considered proarrhythmic (ex-sustained ventricular tachycardia [VT] treated with shock resulting in ventricular fi brillation). Results: Of the 3049 stored events, 380 shock events were identifi ed. Among them, 132 events were induced during AICD implantation for testing purposes and thus excluded. One hundred and eighty were considered appropriate as the device shocked them out of sustained VT. Nine events were considered appropriate and proarrhythmic. Fifty-fi ve were considered inappropriate as the shock was delivered for supraventricular arrhythmia. Four events were considered inappropriate and proarrhythmic as the AICD shocked the clinically inappropriate rhythm resulting in worsening of arrhythmia. Conclusion: We noted 13 proarrhythmic events. Most of them are due to inadvertent recognition of supraventricular arrhythmia and delivering of therapies. Proarrhythmogenicity can be minimized by careful programming of the AICD.

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When Life‐Saving Devices Terminate Life

Abstract: This report describes proarrhythmia, a rare but in this case fatal complication of ICD therapy due to lead failure.

Cited by 22 publications

References 10 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

Preface to the fourth issue of Journal of Cardiovascular Disease Research

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