Performance of Dedicated Versus Integrated Bipolar Defibrillator Leads with CRT‐Defibrillators: Results from a Prospective Multicenter Study

Freedman, Roger A.; Petrakian, Alex; Boyce, Ker; Haffajee, Charles I.; Oza, Ashish

doi:10.1111/j.1540-8159.2008.02197.x

Cited by 17 publications

(8 citation statements)

References 14 publications

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“…The type of ICD lead (dedicated or integrated bipolar) did not influence NAO and this observation should help clarify ongoing discussion regarding the difference in sensing between shocking lead types 18,19 . While the incidence of T‐wave oversensing, atrial oversensing on the ventricular lead, and muscle oversensing was very low, these episodes may be expected to be more common in integrated bipolar leads compared to dedicated bipolar leads.…”

Section: Discussionmentioning

confidence: 78%

Noise, Artifact, and Oversensing Related Inappropriate ICD Shock Evaluation: ALTITUDE NOISE Study

Powell¹,

Asirvatham²,

Perschbacher³

et al. 2012

Pacing Clinical Electrophis

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Section: Discussionmentioning

confidence: 78%

Noise, Artifact, and Oversensing Related Inappropriate ICD Shock Evaluation: ALTITUDE NOISE Study

Powell¹,

Asirvatham²,

Perschbacher³

et al. 2012

Pacing Clinical Electrophis

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“…Anodal stimulation has been also described in patients receiving a CRT system, especially in those involving RV defibrillation lead with a true bipolar design for the pace/sense function . Integrated bipolar RV defibrillator leads (those that utilize the distal shocking coil as the proximal pacing electrode) showed a significantly lower incidence of RV anodal stimulation when compared to dedicated bipolar RV defibrillation leads . Today true bipolar LV leads (allow the option of programming bipolar pacing between two electrodes of the same LV lead) allow avoidance of this phenomenon excluding the RV lead from the LV pacing configuration.…”

Section: Discussionmentioning

confidence: 99%

“…7 Integrated bipolar RV defibrillator leads (those that utilize the distal shocking coil as the proximal pacing electrode) showed a significantly lower incidence of RV anodal stimulation when compared to dedicated bipolar RV defibrillation leads. 8 Today true bipolar LV leads (allow the option of programming bipolar pacing between two electrodes of the same LV lead) allow avoidance of this phenomenon excluding the RV lead from the LV pacing configuration. New quadripolar LV leads allow different true bipolar pacing configurations for better stimulation threshold or avoidance of phrenic stimulation.…”

Section: Pace Vol 38mentioning

confidence: 99%

Anodal Stimulation in Biventricular Pacing: Unrecognized and Misinterpreted Phenomenon

Bénézet-Mazuecos

Iglesias

Rubio

et al. 2015

Pacing and Clinical Electrophysiology

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anodal stimulation, biventricular pacing, CRT devices Clinical ProblemAn 84-year-old patient with history of nonischemic dilated cardiomyopathy with severe systolic dysfunction (left ventricular ejection fraction [LVEF] 30%), heart failure symptoms (New York Heart Association [NYHA] class III), sinus rhythm, and left bundle branch block (LBBB; QRS duration 140 ms) with a cardiac resynchronization therapy (CRT) pacemaker Anthem TM (St. Jude Medical, St. Paul, MN, USA) attended to scheduled device check-up (Fig. 1). Since CRT implantation 1 year before, the patient's clinical situation had mildly improved to NYHA classes II-III, and LVEF was 35%. Device interrogation showed a biventricular pacing >99%. Right atrial and right ventricular (RV) stimulation threshold tests were performed normally (0.75 V at 0.4 ms and 0.75 V at 0.5 ms, respectively). Automatic left ventricular (LV) stimulation threshold was 3.0 V at 0.5 ms in bipolar configuration (tip LV-proximal ring RV). In order to optimize LV output, stimulation threshold for both configurations (bipolar and unipolar) were assessed using simultaneous electrocardiogram recording. LV stimulation threshold test in unipolar configuration showed a threshold of 2.75 V at 0.5 ms. LV threshold test in bipolar configuration (tip LV-proximal ring RV) showed an interesting phenomenon: at the beginning of the test, LV stimulation produced narrow biventricular stimulation QRS morphology; with the decreasing output energy it changed to RV stimulation QRS morphology and finally it showed lost capture (Fig. 2). DiscussionAnodal stimulation is a phenomenon of activation of the myocardium in proximity to the anode. Pectoral muscle stimulation is a classic example of anodal stimulation associated with unipolar pacing. Biventricular pacing systems that utilize a unipolar lead for LV pacing via a coronary vein may create RV anodal pacing.1 The tip electrode of the LV lead is the cathode, and the proximal electrode of the bipolar RV lead often provides the anode for LV pacing. This arrangement creates a common anode for RV and LV pacing. A high current at the common anode during biventricular pacing may cause anodal capture, manifested as a paced QRS complex with a somewhat different configuration from that derived from standard biventricular pacing. During LV pacing at a relatively high output, RV anodal capture produces a paced QRS complex identical to that registered with biventricular pacing (Fig. 3). As we documented in our case, occasionally this type of anodal capture prevents electrocardiographic documentation of pure LV pacing if the LV pacing threshold is higher than that of RV anodal stimulation. Such anodal stimulation may complicate threshold testing and should not be misinterpreted as pacemaker malfunction. Moreover, in our case, it showed that the real LV stimulation threshold was 3.75 V at 0.5 ms for bipolar configuration and the automatic stimulation threshold algorithm considered RV paced beats as LV captures during the test (Fig. 2). Since the device can not accurat...

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“…In a direct comparison of the 2 leads, Degeratu et al reported that there were more inappropriate arrhythmia detection (because of lead failure) with dedicated bipolar leads than with integrated bipolar leads (17.8% versus 4.3%). 16 Nevertheless, Freedman et al 17 in a study with 292 patients who were randomly assigned to receive dedicated or integrated bipolar RV leads at the time of cardiac resynchronization therapy-defibrillator implantation reported that integrated bipolar RV defibrillator leads had a significantly lower incidence of RV anodal stimulation when compared with dedicated bipolar RV defibrillation leads, but with no clinically detectable oversensing or undersensing, and with no inappropriate ventricular tachyarrhythmia detections for either lead type. Whether sensing configuration has any relevance in patients with BrS has not been specifically evaluated.…”

Section: Discussionmentioning

confidence: 99%

T-Wave Oversensing in Patients With Brugada Syndrome: True Bipolar Versus Integrated Bipolar Implantable Cardioverter Defibrillator Leads

Rodríguez‐Mañero

Asmundis

Sacher

et al. 2015

Circ: Arrhythmia and Electrophysiology

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Background-It is thought that dedicated bipolar are more susceptible to T-wave oversensing when compared with integrated bipolar leads. This could be of extreme importance in patients with Brugada syndrome (BrS) because T-wave oversensing in this population is more frequent when compared with other implantable cardioverter defibrillator (ICD) recipients without BrS. We aimed to compare the incidence of T-wave oversensing in patients with BrS according to the type of lead (integrated bipolar versus true/dedicated bipolar). Methods and Results-All patients diagnosed with BrS with an ICD implant in 10 tertiary hospitals between 1993 and 2013were included in the study. A total of 480 patients were included (mean age, 45.6±14 years). During a mean follow-up of 74.9±51.7 months (median, 69; range, 2-236), 28 patients had T-wave oversensing (5.8%), leading to inappropriate shock in 18 (3.8%). All these events occurred in patients with true bipolar ICD leads (P=0.01) and in 2 patients it was solved instantaneously by changing the configuration from a dedicated to an integrated bipolar sensing configuration. In the stepwise multivariate models, only integrated bipolar ICD leads (hazard ratio, 0.34; 95% confidence interval, 0.171-0.675; P=0.002) was independent predictor of non-T-wave oversensing. Conclusions-T-wave oversensing is a potential reason of inappropriate shocks in patients with BrS receiving ICDs. In the vast majority it can be solved by reprogramming. However, in some patients it still requires invasive intervention. Importantly, incidence is significantly lower using an integrated bipolar lead system when compared with a dedicated bipolar lead system and hence the latter should be routinely used in BrS cases. Rodríguez-Mañero et al T-Wave Oversensing in Brugada Syndrome 793oversensing when compared with integrated bipolar leads, probably because of greater variations in R-wave amplitude. 3,4 This could be of extreme importance in BrS because T-wave oversensing in this population has been reported to be more frequent. 5We aimed to compare the incidence of T-wave oversensing in patients with BrS according to the type of ICD lead (integrated bipolar [coil plus distal lead electrode] versus dedicated bipolar). MethodsAll patients diagnosed with BrS and implanted with an ICD in 10 tertiary hospitals between 1993 and 2013 were included in the study. The diagnosis was made after an episode of aborted sudden cardiac arrest, during evaluation of syncope, in asymptomatic patients with a suggestive ECG pattern recorded during routine examination, or as a consequence of familial screening after the diagnosis of BrS in a family member. This registry was approved by the institutional review committee, and the subjects gave informed consent.Patients were included in the study if they had a type 1 Brugada pattern on ECG at baseline on at least 1 occasion or after provocation with a class I antiarrhythmic drug (determined by its availability in the participating hospitals; ajmaline, pilsicainide, flecainide, or procainamida...

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Performance of Dedicated Versus Integrated Bipolar Defibrillator Leads with CRT‐Defibrillators: Results from a Prospective Multicenter Study

Abstract: Introduction: Right ventricular (RV) anodal stimulation may occur in cardiac resynchronization therapy defibrillators (CRT-D) when left ventricular (LV) (PACE 2009; 32:157-165) integrated, dedicated, anodal stimulation, undersensing, oversensing, inappropriate therapies

Cited by 17 publications

References 14 publications

Noise, Artifact, and Oversensing Related Inappropriate ICD Shock Evaluation: ALTITUDE NOISE Study

Noise, Artifact, and Oversensing Related Inappropriate ICD Shock Evaluation: ALTITUDE NOISE Study

Anodal Stimulation in Biventricular Pacing: Unrecognized and Misinterpreted Phenomenon

T-Wave Oversensing in Patients With Brugada Syndrome: True Bipolar Versus Integrated Bipolar Implantable Cardioverter Defibrillator Leads

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