1
|
Baronetto A, Amft O. AIM in Wearable and Implantable Computing. Artif Intell Med 2022. [DOI: 10.1007/978-3-030-64573-1_299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
|
2
|
Mukherjee RK, Sohal M, Shanmugam N, Pearse S, Jouhra F. Successful Identification of and Discrimination Between Atrial and Ventricular Arrhythmia with the Aid of Pacing and Defibrillator Devices. Arrhythm Electrophysiol Rev 2021; 10:235-240. [PMID: 35106174 PMCID: PMC8785083 DOI: 10.15420/aer.2021.54] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 10/25/2021] [Indexed: 11/15/2022] Open
Abstract
The presence of supraventricular tachycardia is the leading cause of inappropriate shock in ICD recipients, and it can be a significant cause of morbidity, psychological distress and worsened clinical outcome. Modern pacing and ICD systems offer a number of discriminators that are integrated into algorithms to differentiate sustained ventricular tachycardia from supraventricular tachycardia. These algorithms can be adapted and optimised for each individual patient to ensure that only those arrhythmias that need treatment through the use of an ICD, are actually treated. This review summarises the single- and dual-chamber discriminators that can be used in the detection and classification of tachyarrhythmias.
Collapse
Affiliation(s)
- Rahul K. Mukherjee
- Department of Cardiology, St George’s University Hospital NHS Foundation Trust, London, UK
- Division of Imaging Sciences and Biomedical Engineering, St Thomas’ Hospital, King’s College London, UK
| | - Manav Sohal
- Department of Cardiology, St George’s University Hospital NHS Foundation Trust, London, UK
| | - Nesan Shanmugam
- Department of Cardiology, St George’s University Hospital NHS Foundation Trust, London, UK
| | - Simon Pearse
- Department of Cardiology, Kingston Hospital, London, UK
| | - Fadi Jouhra
- Department of Cardiology, St George’s University Hospital NHS Foundation Trust, London, UK
| |
Collapse
|
3
|
Datta T, Melnick S, Rajaram B, Pavri BB. A Shocking Case of Far-Field Atrial Oversensing in Giant-Cell Myocarditis. JACC Case Rep 2021; 3:603-609. [PMID: 34317586 PMCID: PMC8302787 DOI: 10.1016/j.jaccas.2021.02.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 01/21/2021] [Accepted: 02/05/2021] [Indexed: 11/25/2022]
Abstract
We report a unique case of delivery of inappropriate implantable cardioverter-defibrillator therapies related to a "perfect storm": presence of an integrated lead, insufficient lead slack related to right heart dilation resulting in shock coil misplacement, myocarditis with loss of R waves, and the concomitant occurrence of an incessant atrial tachycardia. (Level of Difficulty: Advanced.).
Collapse
Affiliation(s)
- Tanuka Datta
- Department of Internal Medicine, Division of Cardiology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Stephen Melnick
- Department of Internal Medicine, Division of Cardiology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Bharaniabirami Rajaram
- Department of Internal Medicine, Division of Cardiology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Behzad B. Pavri
- Department of Internal Medicine, Division of Cardiology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| |
Collapse
|
4
|
AIM in Wearable and Implantable Computing. Artif Intell Med 2021. [DOI: 10.1007/978-3-030-58080-3_299-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
|
5
|
Reduction of inappropriate implantable cardioverter-defibrillator therapies using enhanced supraventricular tachycardia discriminators: the ReduceIT study. J Interv Card Electrophysiol 2020; 61:339-348. [PMID: 32661865 DOI: 10.1007/s10840-020-00816-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 06/29/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Inappropriate implantable cardioverter-defibrillator (ICD) shocks are associated with greater healthcare resource utilization, poorer quality-of-life, and higher mortality. We aimed to investigate the performance of enhanced supraventricular tachycardia (SVT) discrimination algorithms (morphology discrimination, rate stability, and sudden or chamber onset) for reducing inappropriate ICD therapies in patients with ICD/cardiac resynchronization therapy devices. METHODS This prospective, non-randomized, multicenter study (ReduceIT) study took place at 56 sites across Germany and Estonia. Adults at risk of sudden cardiac death undergoing St. Jude Medical™ ICD or CRT-D implantation were included. The primary endpoint was freedom from inappropriate ICD shock at 12 months and was analyzed in the intention to treat (ITT) and per-protocol population. RESULTS Overall, 733 patients (65.9 ± 11.4 years) were included, of which 40.9% and 59.1% received a single- and dual-chamber detection device, respectively. During follow-up (median 11.9 [0-21.6] months), 96.3% of patients experienced no inappropriate therapy (ITT). The sensitivity, specificity, and accuracy for VT/VF were 91.9%, 95.5%, and 94.7%, respectively. In the per-protocol population (n = 620), the proportion of patients free from inappropriate shock at 12 months was 98.4% (n = 610; 95% CI 97.1-99.2%) and exceeded the expected value of 93% (p < 0.0001) which was derived from the rates in the SPICE, ATPonFastVT, and DECREASE studies. A total of 44 patients (6.0%) died during follow-up, 19 deaths were cardiac-related which is consistent with a meta-analysis of EMPIRIC, MADIT-RIT, ADVANCE III, and PROVIDE. Serious device and procedure-related adverse effects occurred in 9.8% of patients. CONCLUSIONS In ICD/CRT-D devices with advanced SVT discriminators, device programming according to clinical setting and detection chamber significantly reduces the rate of inappropriate ICD shocks without compromising patient safety. The algorithms and settings described herein have particular clinical importance and their employment may be of benefit to ICD recipients.
Collapse
|
6
|
Kossaify A. Sensing and Detection Functions in Implantable Cardioverter Defibrillators: The Good, the Bad and the Ugly. ACTA CARDIOLOGICA SINICA 2020; 36:308-317. [PMID: 32675922 PMCID: PMC7355121 DOI: 10.6515/acs.202007_36(4).20191201a] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 12/01/2019] [Indexed: 12/17/2022]
Abstract
Implantable cardioverter defibrillators are small devices that have been proven to be beneficial by preventing sudden cardiac death, whether in primary or secondary prevention. Appropriate functioning of implantable cardioverter defibrillators is mainly dependent on the "good" sensing of ventricular electrogram waves, allowing for the adequate detection of ventricular arrhythmias in order to deliver appropriate therapy of either antitachycardia pacing or by delivering a shock according to the detected rhythm. Basic sensing function in defibrillators is based on detection rate and detection duration; additional parameters that are involved in the process of adequate detection include ventricular electrogram sensing, auto-adjusting sensitivity, supraventricular arrhythmia discrimination criteria, noise detection, and various dedicated algorithms. Defective sensing may result in the delivery of inappropriate therapy (oversensing) or inappropriate withholding of therapy (undersensing); the latter of which may lead to sudden cardiac death. This paper describes different clinical scenarios and programming tips to avoid abnormal or critical clinical situations.
Collapse
Affiliation(s)
- Antoine Kossaify
- Cardiology Department, Arrhythmia Division, University Hospital Notre Dame des Secours/USEK, Byblos, Lebanon
| |
Collapse
|
7
|
Willems S, Tilz RR, Steven D, Kääb S, Wegscheider K, Gellér L, Meyer C, Heeger CH, Metzner A, Sinner MF, Schlüter M, Nordbeck P, Eckardt L, Bogossian H, Sultan A, Wenzel B, Kuck KH, Piorkowski C, Lebedev D, Kautzner J, Sticherling C, Deneke T, Rostock T, Ukena C, Kuniss M, Makimoto H, Hindricks G, Bänsch D, Schreieck J, Kolb C, Geller J, Pokushalov E, Gutleben K, Sommer P, Boldt L, Parwani A. Preventive or Deferred Ablation of Ventricular Tachycardia in Patients With Ischemic Cardiomyopathy and Implantable Defibrillator (BERLIN VT). Circulation 2020; 141:1057-1067. [DOI: 10.1161/circulationaha.119.043400] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Catheter ablation for ventricular tachycardia (VT) reduces the recurrence of VT in patients with implantable cardioverter-defibrillators (ICDs). The appropriate timing of VT ablation and its effects on mortality and heart failure progression remain a matter of debate. In patients with life-threatening arrhythmias necessitating ICD implantation, we compared outcomes of preventive VT ablation (undertaken before ICD implantation to prevent ICD shocks for VT) and deferred ablation after 3 ICD shocks for VT.
Methods:
The BERLIN VT study (Preventive Ablation of Ventricular Tachycardia in Patients With Myocardial Infarction) was a prospective, open, parallel, randomized trial performed at 26 centers. Patients with stable ischemic cardiomyopathy, a left ventricular ejection fraction between 30% and 50%, and documented VT were randomly assigned 1:1 to a preventive or deferred ablation strategy. The primary outcome was a composite of all-cause death and unplanned hospitalization for either symptomatic ventricular arrhythmia or worsening heart failure. Secondary outcomes included sustained ventricular tachyarrhythmia and appropriate ICD therapy. We hypothesized that preventive ablation strategy would be superior to deferred ablation strategy in the intention-to-treat population.
Results:
During a mean follow-up of 396±284 days, the primary end point occurred in 25 (32.9%) of 76 patients in the preventive ablation group and 23 (27.7%) of 83 patients in the deferred ablation group (hazard ratio, 1.09 [95% CI, 0.62–1.92];
P
=0.77). On the basis of prespecified criteria for interim analyses, the study was terminated early for futility. In the preventive versus deferred ablation group, 6 versus 2 patients died (7.9% versus 2.4%;
P
=0.18), 8 versus 2 patients were admitted for worsening heart failure (10.4% versus 2.3%;
P
=0.062), and 15 versus 21 patients were hospitalized for symptomatic ventricular arrhythmia (19.5% versus 25.3%;
P
=0.27). Among secondary outcomes, the proportions of patients with sustained ventricular tachyarrhythmia (39.7% versus 48.2%;
P
=0.050) and appropriate ICD therapy (34.2% versus 47.0%;
P
=0.020) were numerically reduced in the preventive ablation group.
Conclusions:
Preventive VT ablation before ICD implantation did not reduce mortality or hospitalization for arrhythmia or worsening heart failure during 1 year of follow-up compared with the deferred ablation strategy.
Registration:
URL:
https://www.clinicaltrials.gov
; Unique identifier: NCT02501005.
Collapse
Affiliation(s)
| | - Roland Richard Tilz
- University Hospital Lübeck, Med.Klinik II, and German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck, Germany (R.R.T., C.-H.H.)
| | - Daniel Steven
- University Heart Center Cologne, Germany (D.S., A.S.)
| | - Stefan Kääb
- Department of Medicine I, University Hospital Munich, Ludwig-Maximilian’s University Munich and German Center for Cardiovascular Research (DZHK), partner site Munich Heart Alliance, Germany (S.K., M.F.S.)
| | - Karl Wegscheider
- Institute of Medical Biometry and Epidemiology, University Medical Center Eppendorf, Hamburg, Germany (K.W.)
| | - László Gellér
- Semmelweis Medical University, Budapest, Hungary (L.G.)
| | | | - Christian-Hendrik Heeger
- University Hospital Lübeck, Med.Klinik II, and German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck, Germany (R.R.T., C.-H.H.)
| | | | - Moritz F. Sinner
- Department of Medicine I, University Hospital Munich, Ludwig-Maximilian’s University Munich and German Center for Cardiovascular Research (DZHK), partner site Munich Heart Alliance, Germany (S.K., M.F.S.)
| | | | | | | | | | - Arian Sultan
- University Heart Center Cologne, Germany (D.S., A.S.)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
8
|
Barold SS, Kucher A. Termination of desynchronization rhythm and restoration of cardiac resynchronization by left‐sided ventricular premature complexes. Pacing Clin Electrophysiol 2019; 42:1099-1104. [DOI: 10.1111/pace.13749] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 06/09/2019] [Indexed: 12/01/2022]
Affiliation(s)
- S. Serge Barold
- School of Medicine and DentistryUniversity of Rochester Rochester New York
| | | |
Collapse
|
9
|
Broux B, De Clercq D, Vera L, Ven S, Deprez P, Decloedt A, van Loon G. Can heart rate variability parameters derived by a heart rate monitor differentiate between atrial fibrillation and sinus rhythm? BMC Vet Res 2018; 14:320. [PMID: 30359273 PMCID: PMC6203204 DOI: 10.1186/s12917-018-1650-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 10/16/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Heart rate variability (HRV) parameters, and especially RMSSD (root mean squared successive differences in RR interval), could distinguish atrial fibrillation (AF) from sinus rhythm(SR) in horses, as was demonstrated in a previous study. If heart rate monitors (HRM) automatically calculating RMSSD could also distinguish AF from SR, they would be useful for the monitoring of AF recurrence. The objective of the study was to assess whether RMSSD values obtained from a HRM can differentiate AF from SR in horses. Furthermore, the impact of artifact correction algorithms, integrated in the analyses software for HRV analyses was evaluated. Fourteen horses presented for AF treatment were simultaneously equipped with a HRM and an electrocardiogram (ECG). A two-minute recording at rest, walk and trot, before and after cardioversion, was obtained. RR intervals used were those determined automatically by the HRM and by the equine ECG analysis software, and those obtained after manual correction of QRS detection within the ECG software. RMSSD was calculated by the HRM software and by dedicated HRV software, using six different artifact filters. Statistical analysis was performed using the Wilcoxon signed-rank test and receiver operating curves. RESULTS The HRM, which applies a low level filter, produced high area under the curve (AUC) (> 0.9) and cut off values with high sensitivity and specificity. Similar results were obtained for the ECG, when low level artifact filtering was applied. When no artifact correction was used during trotting, an important decrease in AUC (0.75) occurred. CONCLUSION In horses treated for AF, HRMs with automatic RMSSD calculations distinguish between AF and SR. Such devices might be a useful aid to monitor for AF recurrence in horses.
Collapse
Affiliation(s)
- B Broux
- Equine Cardioteam, Department of Large Animal Internal Medicine, Faculty of Veterinary Medicine, Ghent University, Salisburylaan 133, 9820, Merelbeke, Belgium.
| | - D De Clercq
- Equine Cardioteam, Department of Large Animal Internal Medicine, Faculty of Veterinary Medicine, Ghent University, Salisburylaan 133, 9820, Merelbeke, Belgium
| | - L Vera
- Equine Cardioteam, Department of Large Animal Internal Medicine, Faculty of Veterinary Medicine, Ghent University, Salisburylaan 133, 9820, Merelbeke, Belgium
| | - S Ven
- Equine Cardioteam, Department of Large Animal Internal Medicine, Faculty of Veterinary Medicine, Ghent University, Salisburylaan 133, 9820, Merelbeke, Belgium
| | - P Deprez
- Equine Cardioteam, Department of Large Animal Internal Medicine, Faculty of Veterinary Medicine, Ghent University, Salisburylaan 133, 9820, Merelbeke, Belgium
| | - A Decloedt
- Equine Cardioteam, Department of Large Animal Internal Medicine, Faculty of Veterinary Medicine, Ghent University, Salisburylaan 133, 9820, Merelbeke, Belgium
| | - G van Loon
- Equine Cardioteam, Department of Large Animal Internal Medicine, Faculty of Veterinary Medicine, Ghent University, Salisburylaan 133, 9820, Merelbeke, Belgium
| |
Collapse
|
10
|
Thøgersen AM, Larsen JM, Johansen JB, Abedin M, Swerdlow CD. Failure to Treat Life-Threatening Ventricular Tachyarrhythmias in Contemporary Implantable Cardioverter-Defibrillators: Implications for Strategic Programming. Circ Arrhythm Electrophysiol 2017; 10:e005305. [PMID: 28916511 PMCID: PMC5610568 DOI: 10.1161/circep.117.005305] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2017] [Accepted: 07/14/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND In clinical trials, manufacturer-specific, strategic programming of implantable cardioverter-defibrillators (ICDs), including faster detection rates, reduces unnecessary therapy but permits therapy for ventricular tachycardia/ventricular fibrillation (VF). Present consensus recommends a generic rate threshold between 185 and 200 beats per minute, which exceeds the rate tested in clinical trials for some manufacturers. In a case series, we sought to determine the relationship between programmed parameters and failure of modern ICDs to treat VF. METHODS AND RESULTS We reviewed cases in which normally functioning ICDs failed to deliver timely therapy for VF from April 2015 to January 2017 at 4 institutions. Of 10 ambulatory patients, 5 died from untreated VF, 4 had cardiac arrests requiring external shocks, and 1 was rescued by a delayed ICD shock. VF did not satisfy programmed detection criteria in 9 patients (90%). Seven of these patients had slowest detection rates that were consistent with generic recommendations but not tested in a peer-reviewed trial for their manufacturer's ICDs. Manufacturer-specific factors interacted with fast detection rates to withhold therapy, including strict VF episode termination rules, enhancements to minimize T-wave oversensing, and features that restrict therapy to regular rhythms in ventricular tachycardia zones. Untreated VF despite recommended programming accounted for 56% of sudden deaths and 11% of all deaths during the study period. CONCLUSIONS Complex and unanticipated interactions between manufacturer-specific features and generic programming can prevent therapy for VF. More data are needed to assess the risks and benefits of translating evidence-based detection parameters from one manufacturer to another.
Collapse
Affiliation(s)
- Anna Margrethe Thøgersen
- From the Department of Cardiology, Aalborg University Hospital, Denmark; Department of Cardiology, Odense University Hospital, Denmark (J.B.J.); Paul L. Foster School of Medicine, Texas Tech University Health Science Center, El Paso (M.A.); and Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (C.D.S.)
| | - Jacob Moesgaard Larsen
- From the Department of Cardiology, Aalborg University Hospital, Denmark; Department of Cardiology, Odense University Hospital, Denmark (J.B.J.); Paul L. Foster School of Medicine, Texas Tech University Health Science Center, El Paso (M.A.); and Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (C.D.S.)
| | - Jens Brock Johansen
- From the Department of Cardiology, Aalborg University Hospital, Denmark; Department of Cardiology, Odense University Hospital, Denmark (J.B.J.); Paul L. Foster School of Medicine, Texas Tech University Health Science Center, El Paso (M.A.); and Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (C.D.S.)
| | - Moeen Abedin
- From the Department of Cardiology, Aalborg University Hospital, Denmark; Department of Cardiology, Odense University Hospital, Denmark (J.B.J.); Paul L. Foster School of Medicine, Texas Tech University Health Science Center, El Paso (M.A.); and Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (C.D.S.)
| | - Charles D Swerdlow
- From the Department of Cardiology, Aalborg University Hospital, Denmark; Department of Cardiology, Odense University Hospital, Denmark (J.B.J.); Paul L. Foster School of Medicine, Texas Tech University Health Science Center, El Paso (M.A.); and Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (C.D.S.).
| |
Collapse
|
11
|
Broux B, De Clercq D, Decloedt A, Ven S, Vera L, van Steenkiste G, Mitchell K, Schwarzwald C, van Loon G. Heart rate variability parameters in horses distinguish atrial fibrillation from sinus rhythm before and after successful electrical cardioversion. Equine Vet J 2017; 49:723-728. [DOI: 10.1111/evj.12684] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 03/14/2017] [Indexed: 12/22/2022]
Affiliation(s)
- B. Broux
- Department of Large Animal Internal Medicine, Faculty of Veterinary Medicine; Ghent University; Merelbeke Belgium
| | - D. De Clercq
- Department of Large Animal Internal Medicine, Faculty of Veterinary Medicine; Ghent University; Merelbeke Belgium
| | - A. Decloedt
- Department of Large Animal Internal Medicine, Faculty of Veterinary Medicine; Ghent University; Merelbeke Belgium
| | - S. Ven
- Department of Large Animal Internal Medicine, Faculty of Veterinary Medicine; Ghent University; Merelbeke Belgium
| | - L. Vera
- Department of Large Animal Internal Medicine, Faculty of Veterinary Medicine; Ghent University; Merelbeke Belgium
| | - G. van Steenkiste
- Department of Large Animal Internal Medicine, Faculty of Veterinary Medicine; Ghent University; Merelbeke Belgium
| | - K. Mitchell
- Equine Clinic; University of Zurich; Zurich Switzerland
| | | | - G. van Loon
- Department of Large Animal Internal Medicine, Faculty of Veterinary Medicine; Ghent University; Merelbeke Belgium
| |
Collapse
|