Sensitivity and specificity of the subcutaneous implantable cardioverter defibrillator pre-implant screening tool

Abstract

Background

Subcutaneous ICD screening with the Boston Scientific ZOOM programmer versus a 12‐lead ECG machine

“…Prior studies have suggested that “borderline passes” are more likely to lead to inappropriate shocks . Additional screening options that can be employed in borderline cases to potentially improve screening accuracy include the AST, exercise testing, and an algorithm‐based screening method . Even with these, however, clinical judgment on borderline cases should be used.…”

“…Skin electrodes are placed to mimic the sensing configuration of the S‐ICD. In a study by Zeb et al., the sensitivity and specificity of the screening tool in normal individuals with structurally normal hearts using a standard ECG machine when compared to the S‐ICD sensing algorithm in a computer simulation was 95% and 79%, respectively …”

“…Another limitation is the fact that our default machine filter settings may not reflect those of other institutions and thus the results may not be applicable if other filtering is used. Lastly, the screening tool has been shown to have variable sensitivity and specificity in those with congenital heart disease compared to the actual S‐ICD sensing algorithm and is more accurate in those with normal hearts . Whether there are differences in the accuracy of the ZOOM programmer versus a 12‐lead ECG machine in specific patient populations is unknown.…”

Successful intermuscular implantation of subcutaneous implantable cardioverter defibrillator in a Japanese patient with pectus excavatum

“…The sensing algorithm for this system depends on the surface elecrtrocardiogram (ECG) morphology, specifically the R-and T-wave amplitudes, R/T and R/P ratios, QRS duration and QT interval. A pre-implant screening tool developed by the manufacturer (Boston Scientific Corp., Marlborough, MA, USA) is used in all patients under consideration for this device to select individuals with ECG morphology that offers appropriate signal configuration to satisfy the requirements of the subcutaneous ICD sensing algorithm, which are critical for an appropriate and effective delivery of the ICD implantation therapy [7] .…”

Discrimination between QRS and T Waves Using a Right Parasternal Lead for S‐ICD in a Patient with a Single Ventricle

“…To investigate the adequacy of the S-ICD, an ECG screening test was performed according to a program provided by Boston Scientific (Marlborough, MA, USA). 2 Each of three vectors was evaluated in the supine and standing positions. The secondary vector exclusively passed the screening test and the other two vectors failed in the left parasternal position.…”