Sensing Lead-Related Complications in Patients With Transvenous Implantable Cardioverter-Defibrillators

Lawton, Jennifer S.; Ellenbogen, Kenneth A.; Wood, Mark A.; Stambler, Bruce S.; Herre, John M.; Nath, Sunil; Bernstein, Robert C.; DiMarco, John P.; Haines, David E.; Szentpetery, Szabolcs; Baker, Lenox D.; Damiano, Ralph J.

doi:10.1016/s0002-9149(96)00387-6

Cited by 42 publications

(25 citation statements)

References 20 publications

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“…In a prior investigation, ECG measurements with subcutaneous leads were at greater risk for motion and muscular artifact compared to epicardial leads during treadmill exercise in animals. 18 However, in our study, QRS detection with subcutaneous leads and standard signal processing was not impaired during normal daily activity or treadmill exercise as evidenced by positive predictive values >95% and sensitivity values >90% (mean 93.3 ± 5.6%) during Symphony support. The selected location of the subcutaneous leads provided excellent R wave and moderate T wave amplitudes, which minimized the number of false 'missed beats' and 'double triggering' events.…”

Section: Discussioncontrasting

confidence: 47%

“…14 Postoperative complications, though uncommon, have been reported with transvenous leads and include lead dislodgment, lead fracture, subclavian vein thrombosis, sensing abnormalities, and lead infection. 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.…”

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: Discussioncontrasting

confidence: 47%

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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“…The latter is often the mode of presentation. Oversensing of noise can also be noted during device interrogation: either from stored data of non-sustained episodes or directly during manipulation of the generator pocket [2,4,6,11,14,15] . Oversensing from pace-sense lead dysfunction has to be distinguished from external noise sources, myopotentials or electrical interference with other leads.…”

Section: Introductionmentioning

confidence: 99%

Malfunction of endocardial defibrillator leads and lead extraction: where do they meet?

2002

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From this overview we conclude that malfunctioning pace-sense or ICD leads can be left in situ if there are no uncovered insulation defects. Inserting a new pace-sense or ICD lead is preferable in this situation given the current known complication rate of lead extraction. Lead extraction should be reserved for damaged leads in which interference with proper detection or defibrillation of newly inserted leads cannot be excluded.

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“…The ICD leads are significantly more complex in design than pacemaker leads and may be more susceptible to lead failure (3)(4)(5)(6)(7)(8)(9). The higher sensitivity used in ICD sense amplifiers makes them more susceptible to oversensing of noise signals than pacemakers.…”

mentioning

confidence: 99%

An algorithm to predict implantable cardioverter-defibrillator lead failure

Gunderson

Patel

Bounds

et al. 2004

Journal of the American College of Cardiology

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Sensing Lead-Related Complications in Patients With Transvenous Implantable Cardioverter-Defibrillators

Cited by 42 publications

References 20 publications

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

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

Malfunction of endocardial defibrillator leads and lead extraction: where do they meet?

An algorithm to predict implantable cardioverter-defibrillator lead failure

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