.png){kind=icon}
Return
Interpreting device diagnostics for lead failure
.png){kind=icon}
PRE
AI
DOI：10.1016/j.hrthm.2021.09.027.png)
.png){kind=icon}
Original request for help.png){kind=icon}
Share.png){kind=icon}
Save
Abstract
En 中文
Implantable cardioverter-defibrillators (ICDs) incorporate automated, lead-monitoring alerts (alerts) and other diagnostics to detect defibrillation lead failure (LF) and minimize its adverse clinical consequences. Partial conductor fractures cause oversensing, but pacing or high-voltage alerts for high impedance detect only complete conductor fracture. In both pacing and high-voltage insulation breaches, low-impedance alerts require complete breach with metal-to-metal contact. Oversensing alerts for pace-sense LF also require complete breach, but not metal-to metal contact. Electrograms (EGMs) from leads with confirmed fractures have characteristics findings. In insulation breach, however, oversensed EGMs reflect characteristics of the source signal. Oversensing alerts that operate on the sensing channel analyze R-R intervals for 2 patterns typical of LF but uncommon in other conditions: a rapidly increasing count of nonphysiological short intervals and rapid nonsustained tachycardias. These alerts are sensitive but nonspecific. Alerts that compare sensing and shock channels define oversensing as sensed events that do not correlate temporally with EGMs on the shock channel. Their performance depends on implementation. Specific advantages and limitations are reviewed. Most ICDs measure impedance using subthreshold pulses. Patterns in impedance trends provide diagnostic information, whether or not an alert is triggered. Gradual increases in impedance do not indicate structural LF, but they may cause failed defibrillation if shock impedance is high enough. Because impedance-threshold alerts are insensitive, normal impedance trends never exclude LF, but an abrupt increase that triggers an alert almost always indicates a header connection issue or LF. Methods for discriminating connection issues from LF are reviewed. (C) 2021 Heart Rhythm Society. All rights reserved.
Keywords:
Implantable cardioverter-defibrillator
Lead diagnostics
Lead dysfunction
Lead failure
Pacemaker
Journal
IF:
5.7
Papers:
9.7K
Citations:
1.6W
Organization
View more organizations
Cited Papers
ShareSave
ShareSaveMulticenter investigation of an implantable cardioverter-defibrillator algorithm to detect oversensing.png)
HEART RHYTHM
HEART RHYTHMIF5.7
PREAI
ShareSave View more