Clinical performance of implantable cardioverter-defibrillator lead monitoring diagnostics

Time course of oversensing and impedance changes in developing implantable cardioverter-defibrillator lead fracture

“… 7 LIA has been studied more extensively than any other oversensing diagnostic. 3 , 4 , 5 , 10 , 12 The only other reports of another oversensing diagnostic 6 or determination of oversensing using real time EGMs 11 showed earlier warning than impedance diagnostics before inappropriate VF detection.…”

“…In vitro bending tests 8 show that small changes in pacing impedance or DCR are sensitive for conductor fracture, 2 but clinical lead monitoring alerts that measure oversensing are more sensitive than those that measure impedance. 3 , 4 , 5 , 6 , 10 , 11 , 12 Usually, bending tests are performed on short conductor segments, rather than on complete leads, continued to complete fracture so that the onset of partial fracture is not determined, and performed in air so that fracture-induced signals cannot be recorded. 8 By testing complete leads connected to an ICD generator in saline, we determined the sequences of EGM and DCR or impedance changes and correlated them, both with each other and with structural changes in developing fractures.…”

“…This is conservative based on clinical median time from implantation to LIA oversensing alerts for conductor fracture of 118 months. 10 …”

2023 HRS/EHRA/APHRS/LAHRS Expert Consensus Statement on Practical Management of the Remote Device Clinic

“…RM allows effective and safe surveillance of device functioning with alerts for battery depletion, circuit disruption, and lead failure, ensuring device function and integrity. Early detection of malfunctions when the patient is still asymptomatic may prevent catastrophic consequences, particularly in cases of lead or device advisory 21,39,69–71 . RM also allows for continuous connectivity of pacing thresholds, allowing optimization of battery longevity 72–74 …”

“…Many manufacturers currently provide mobile smartphone applications 75 that can facilitate CIED RM transmission and alert patients to the status of RM connectivity, encouraging patient engagement and partnership vital to maintaining RM 76–78 . Consistent connectivity is critical to maximize RM benefits by early detection of actionable events, allowing for early intervention for arrhythmias and HF decompensation, with potential to improve overall patient outcomes 19,21,22,56,69–72 . Timely reaction to implanted system technical failure as well as to changes in clinical status may impact patient outcomes 73–75 …”