Is Surface ECG a Useful Surrogate for Subcutaneous ECG?

Black, Carissa L. Bellardine; Stromberg, Kurt; Balen, Georgette Plemper Van; Ghanem, Raja N.; Breedveld, R.; Tieleman, Robert G

doi:10.1111/j.1540-8159.2009.02616.x

Cited by 27 publications

(18 citation statements)

References 23 publications

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“…10,25 A longer timing error can produce adverse effects by increasing ventricular afterload during systole and diminishing coronary and end-organ flow during diastole. In this study, 150 ms was selected as a metric for evaluating sensitivity and specificity of Symphony timing (control algorithm), which is consistent with values reported in literature for IABP 3,22 and in accordance with ANSI/AAMI EC 57 standard. Unlike IABP, timing with the Symphony is a lot more forgiving.…”

Section: Discussionmentioning

confidence: 88%

“…18,26 Subcutaneous lead systems (a term broadly used to indicate lead positioning in the space external to the pericardium but below the dermis) have been developed for use in cardiac rhythm monitors. 1,9,13 Subcutaneous leads have long been theorized to be an adequate surrogate for surface signals 12 and QRS detection, 5 have been shown to be less susceptible to motion artifacts than surface leads, 3 and have recently been used in a subcutaneous implantable cardioverter-defibrillator. 1 To overcome the limitations associated with surface and transvenous ventricular ECG leads, a subcutaneous ECG system was developed.…”

Section: Discussionmentioning

confidence: 99%

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Feasibility of Subcutaneous ECG Leads for Synchronized Timing of a Counterpulsation Device

Warren

Giridharan

Dowling

et al. 2011

Cardiovasc Eng Tech

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A counterpulsation device (Symphony) that works synchronously with the native heart to provide partial circulatory support was developed to treat patients with advanced heart failure. Symphony is implanted in a 'pacemaker pocket' without entry into the chest, and requires timing with ECG for device filling and ejection. Surface leads are limited to short-term use due to signal distortion and lead management. Transvenous leads are a clinical standard for pacemakers and internal defibrillators, but increase the complexity of the implant procedure. In this study, the feasibility of using subcutaneous leads for synchronized timing of Symphony was investigated. ECG waveforms were simultaneously measured and recorded using epicardial (control) and subcutaneous (test) leads in a bovine model for 7-days (n = 6) and 14-days (n = 2) during daily activity and treadmill exercise. Landmark features and R-wave triggering detection rates for each lead configuration were calculated and compared. Lead placement, migration, durability, and infection were quantified using fluoroscopy and histopathological examination. There were 2,849 data epochs (30-s each) recorded at rest (133,627 analyzed beats) and 35 data epochs (20 min each) recorded during treadmill exercise (37,154 analyzed beats). The subcutaneous leads provided an accurate and reliable triggering signal during routine daily activity and treadmill exercise (99.1 ± 0.4% positive predictive value, 96.8 ± 1.5% sensitivity). The subcutaneous leads were also easily placed with minimal lead migration (0.5 ± 0.1 cm), damage (no fractures or failures), or infection. These findings demonstrate the feasibility of using subcutaneous leads for synchronized timing of mechanical circulatory support while offering the advantage of less invasive surgery and associated risk factors.

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Section: Discussionmentioning

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Feasibility of Subcutaneous ECG Leads for Synchronized Timing of a Counterpulsation Device

Warren

Giridharan

Dowling

et al. 2011

Cardiovasc Eng Tech

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“…If a lead fractures or migrates resulting in loss of signal or signal strength, it automatically switches to the other lead pair for ECG signal, providing redundancy. 27, 28 Once a design freeze has been achieved, clinical-grade subcutaneous leads will complete validation and verification (V&V) testing to demonstrate a lower failure rate comparable or better than with clinically-approved epicardial leads.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of Subcutaneous Electrocardiogram Leads for Synchronous Timing During Chronic Counterpulsation Therapy

Carnahan

Koenig

Sobieski³

et al. 2017

ASAIO Journal

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Counterpulsation devices (CPD) require an accurate, reliable electrocardiogram (ECG) waveform for triggering inflation and deflation. Surface electrodes are for short-term use and transvenous/epicardial leads require invasive implant procedure. A subcutaneous ECG lead configuration was developed as an alternative approach for long-term use with timing mechanical circulatory support (MCS) devices. In this study, efficacy testing was completed by simultaneously recording ECG waveforms from clinical-grade epicardial (control) and subcutaneous (test) leads in chronic ischemic heart failure (IHF) calves implanted with CPD for up to 30 days. Sensitivity and specificity of CPD triggering by R-wave detection was quantified for each lead configuration. The subcutaneous leads provided 98.9% positive predictive value and 98.9% sensitivity compared to the epicardial ECG leads. Lead migration (n=1) and fracture (n=1) were observed in only two of forty implanted leads, without adversely impacting triggering efficacy due to lead redundancy. These findings demonstrate the efficacy of subcutaneous ECG leads for long-term CPD timing and potential use as an alternative method for MCS device timing.

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“…22 Presently, >90% of patients pass this screening. [41][42][43][44] Additional screening during exercise testing may be considered to ensure that exercise-induced repolarization changes do not cause T-wave oversensing. 38 However, screening cannot identify oversensing during asymptomatic VT that alters QRST complexes; and double counting during even slow VT produces intervals in a shock zone.…”

Section: Screening Of S-icd Candidates Using the Ecgmentioning

confidence: 99%

“…22,41 The screening process rejects patients who have QRST complexes in which the QRS amplitude is too large, the QRS duration is too long, or the ratio of QRS amplitude to T-wave amplitude is insufficient. Screening is performed in both supine and standing positions because the unrectified R/T ratio is sensitive to posture.…”

Section: Screening Of S-icd Candidates Using the Ecgmentioning

confidence: 99%