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

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. We developed and tested an algorithm to enh...

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Bibliographic Details
Published in:Circulation (New York, N.Y.) N.Y.), 2008-11, Vol.118 (21), p.2122-2129
Main Authors: SWERDLOW, Charles D, GUNDERSON, Bruce D, OUSDIGIAN, Kevin T, ABEYRATNE, Athula, STADLER, Robert W, GILLBERG, Jeffrey M, PATEL, Amisha S, ELLENBOGEN, Kenneth A
Format: Article
Language:English
Subjects:
Algorithms
Biological and medical sciences
Blood and lymphatic vessels
Cardiology. Vascular system
Defibrillators, Implantable
Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous
Electric Impedance
Equipment Failure
Equipment Failure Analysis
Humans
Medical sciences
Monitoring, Physiologic - instrumentation
Monitoring, Physiologic - methods
Orthopedic surgery
Shock, Cardiogenic - prevention & control
Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases
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Summary: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. 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
ISSN:0009-7322
1524-4539
DOI:10.1161/CIRCULATIONAHA.108.796136