ICD
Patient AlertTM to detect ICD lead failure: efficacy, limitations, and implications for future algorithms
1 Abteilung Kardiologie und Pneumologie, Herzzentrum, Georg-August-Universität Göttingen, Germany; 2 Justus-Liebig-Universität Gießen, Germany; 3 Johannes-Gutenberg-Universität Mainz, Germany; 4 Klinikum Kassel, Germany; 5 Medtronic Bakken Research Center, Maastricht, The Netherlands; 6 Kerckhoff-Klinik Bad Nauheim, Germany
Aims An algorithm that alerts implantable cardioverter-defibrillator (ICD) patients, in case of abnormal lead impedance (Patient AlertTM, Medtronic), may help to recognize lead dysfunction. We aimed to determine the utility of Patient Alert for ICD lead-failure detection in a prospective study.
Methods and results Three hundred and sixty ICD patients were followed for 22±14 months. Patient Alert was active for pacing impedance <200 and >2000–3000 
, and high-voltage conductor impedance <10–20 and >200 . Ten alert events and a total of 29 severe system complications occurred. Patient Alert detected three of 10 ICD lead failures, with a positive predictive value (PPV) of 77.8% for any severe system complication. Retrospective analysis identified 23 patients with a sensing integrity counter (SIC) >300 and revealed an additional four prior undetected lead defects. SIC detected ICD lead failure with 92.9% sensitivity and a PPV of 59.1%. Eight of nine patients with a false-positive SIC had an integrated bipolar lead. Patient Alert combined with SIC detected all ICD lead failures and 71.4% of all severe lead complications.
Conclusions Patient Alert, based on daily lead-impedance measurement, detected one-third of all ICD lead failures. Combined use with continuous lead integrity monitoring (SIC) increased sensitivity to 100%. Integrated bipolar leads may yield a false-positive SIC. Incorporating SIC and automated pace/sense threshold measurement may improve Patient Alert sensitivity for severe lead complications.
Key Words: Implantable cardioverter-defibrillator, Lead failure, Impedance measurement, Oversensing, Complication
* Corresponding author. Tel: +49 551 39 9625; fax: +49 551 39 9628. E-mail address: dirkvollmann2000{at}aol.com
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  H. Burri and D. Senouf Remote monitoring and follow-up of pacemakers and implantable cardioverter defibrillators Europace, June 1, 2009; 11(6): 701 - 709. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. E. Marine Remote monitoring for prevention of inappropriate implantable cardioverter defibrillator shocks: is there no place like home? Europace, April 1, 2009; 11(4): 409 - 411. [Full Text] [PDF]
|
|
|
|
|
|
A. Goette, F. Cantu, L. van Erven, P. Geelen, F. Halimi, J. L. Merino, J. M. Morgan, and on behalf of the Scientific Initiative Committee o Performance and survival of transvenous defibrillation leads: need for a European data registry Europace, January 1, 2009; 11(1): 31 - 34. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. D. Swerdlow, B. D. Gunderson, K. T. Ousdigian, A. Abeyratne, R. W. Stadler, J. M. Gillberg, A. S. Patel, and K. A. Ellenbogen Downloadable Algorithm to Reduce Inappropriate Shocks Caused by Fractures of Implantable Cardioverter-Defibrillator Leads Circulation, November 18, 2008; 118(21): 2122 - 2129. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. Vollmann, L. Luthje, and M. Zabel Far-field oversensing of atrial signals: an unusual cause for very short V-V intervals and inappropriate implantable cardioverter defibrillator therapy Europace, August 1, 2008; 10(8): 1009 - 1011. [Full Text] [PDF]
|
|
|
|
 |
|
 L. van Erven and M. J Schalij Troubleshooting implantable cardioverter-defibrillator related problems Heart, May 1, 2008; 94(5): 649 - 660. [Full Text] [PDF]
|
|
|
|
|
|
D. Vollmann, L. Luthje, and M. Zabel Unusual cause for an increase of the sensing integrity counter in a patient with inappropriate implantable cardioverter-defibrillator therapy Europace, May 1, 2007; 9(5): 275 - 277. [Abstract] [Full Text] [PDF]
|
|