Implantable Cardioverter-Defibrillator Leads

Swerdlow, Charles D.; Ellenbogen, Kenneth A.

doi:10.1161/circulationaha.113.003920

Cited by 44 publications

(32 citation statements)

References 35 publications

(46 reference statements)

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“…Oversensed signals caused by pace-sense lead failure have specific interval patterns and EGM characteristics [145,147,148]. Present algorithms identify three features: (1) intervals can be too short to represent successive ventricular activations; (2) such short intervals are often transient and can be repetitive; and (3) in true bipolar leads, oversensed signals are absent on the shock EGM.…”

Section: Lead-related Oversensingmentioning

confidence: 99%

2015 HRS/EHRA/APHRS/SOLAECE expert consensus statement on optimal implantable cardioverter-defibrillator programming and testing

et al. 2016

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Section: Lead-related Oversensingmentioning

confidence: 99%

2015 HRS/EHRA/APHRS/SOLAECE expert consensus statement on optimal implantable cardioverter-defibrillator programming and testing

et al. 2016

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“…Oversensing of pectoral myopotentials on dedicated bipolar electrograms typically indicates an in-pocket insulation breach 55 ( Figure 9). Such breaches may also cause oversensing on integrated bipolar electrograms.…”

Section: Pectoral Myopotentialsmentioning

confidence: 99%

“…These signals often are referred to as make-break potentials because indistinguishable signals can be generated by connecting and disconnecting cables from the sensing circuit 81 and because it is surmised that a similar process applies during intermittent contact between fractured sections of the helix or broken filaments of a cable. 55 However, make-break potentials do not explain how pacing can induce similar, fracture-related signals. 82 The typical signal has 6 characteristics, of which the first 3 are almost always present ( Figure 11 (Figure 12), but it can take multiple forms (Figure 12).…”

Section: Oversensing Nonphysiological Signals From Lead Problems Overmentioning

confidence: 99%

“…10 Inside-out insulation breaches 83 may cause mechanical interactions between the 2 shock components, the 2 pace-sense components (ring cable and central helix), or 1 pace-sense and 1 shock component. 15,55 The latter 2 may present as oversensing. Inside-out breaches of Riata leads often have characteristic spikes on the sensing channel or both sensing and shock channels that may represent such mechanical interactions 10 ( Figures 12 and 13).…”

Section: Oversensed Signals In Insulation Breachesmentioning

confidence: 99%

“…Inside-out insulation breaches 55,83,93 resulting in contact between a pace-sense conductor and shock coil may trigger alerts because of oversensing on the pace-sense conductor. 15 If the shock electrogram is recorded, it may show simultaneous nonphysiological signals (Figures 3 and 13) 10,15 For this reason, the RV coil-SVC coil electrogram should be monitored on Riata leads at risk for this failure mode.…”

Section: Role Of Electrograms In Suspected Failure Of Highvoltage Commentioning

confidence: 99%

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Troubleshooting Implanted Cardioverter Defibrillator Sensing Problems I

Swerdlow

Asirvatham

Ellenbogen

et al. 2014

Circ: Arrhythmia and Electrophysiology

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electrograms from floating bipolar atrial electrodes on defibrillation leads. 12,13 The former requires a dual-coil lead and the latter a specialized lead. Evaluating Sensing From ICD ElectrogramsFilter settings may influence electrogram appearance (Figure 2). Wideband signals with minimal filtering reproduce QRS complexes accurately and retain the distinctive, rounded appearance of T waves. Highly filtered narrowband signals display the signal that is compared with the sensing threshold in the sensing process, but they alter signal amplitude and polarity, markedly reducing the amplitude of signals with prominent low-frequency components, such as T waves and some components of VF ( Figure I in the Data Supplement). Programmable filter settings (St. Jude Medical and Biotronik) permit assessing the effect of filtering on R-and T-wave amplitude.Sampling is the process of converting an analog signal into a digital sequence. It must be performed at ≥2× the source's signal frequency to reproduce the source's information content completely. ICD telemetry reproduces cardiac signals completely because it samples at 128 to 256 Hz per channel, but it may distort nonphysiological signals periodically (Figure II in the Data Supplement) 14 and it may not completely reproduce myopotentials that have frequency content >100 Hz. Stored Versus Real-Time ElectrogramsStored electrograms and their corresponding interval and episode data are the primary sources for diagnosing devicedetected tachycardias. Real-time electrograms are useful in troubleshooting reproducible oversensing: lead or connector problems in the pocket may be identified by pocket manipulation, pectoral or diaphragmatic myopotentials can be provoked by pectoral muscle contraction and straining or deep breathing, respectively (Figure III in the Data Supplement). Differential electrograms recorded simultaneously between 1 common electrode and 2 different electrodes are useful when lead or connector-related oversensing is suspected (Figure 3). Role of Additional Diagnostics, Alerts, and Remote MonitoringTrend plots of P-and R-wave amplitude, impedance measurements and trends, and algorithms that identify oversensing facilitate electrogram interpretation as discussed below. Alerts for suspected oversensing may notify the patient using audible tones or pulse generator vibration, may be transmitted via internet-based remote-monitoring networks, or both. Remote monitoring has transformed follow-up of sensing problems, permitting rapid determination of cause of an alert and implementation of a response plan, especially for devices with wireless telemetry.16,17 Troubleshooting Ventricular OversensingPresentation, Classification, and Recognition Clinical PresentationIn ICD patients, ventricular oversensing of rapid signals presents as oversensing alerts or inappropriate detection of VT/ VF, often resulting in inappropriate shocks. In pacemakerdependent patients it also presents as failure to deliver bradycardia pacing. ClassificationOversensing can be classified by electro...

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Patient Study 64

Saksena

2015

Patient Studies in Valvular, Congenital, and Rarer Forms of Cardiovascular Disease

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Implantable Cardioverter-Defibrillator Leads

Cited by 44 publications

References 35 publications

2015 HRS/EHRA/APHRS/SOLAECE expert consensus statement on optimal implantable cardioverter-defibrillator programming and testing

2015 HRS/EHRA/APHRS/SOLAECE expert consensus statement on optimal implantable cardioverter-defibrillator programming and testing

Troubleshooting Implanted Cardioverter Defibrillator Sensing Problems I

Patient Study 64

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