1
|
Qi Q, Yu M, Ge J, Li C, Zhang G, Chen F. A combined impedance compensation strategy applied to external automatic defibrillators. BIOMED ENG-BIOMED TE 2023; 68:651-665. [PMID: 37350466 DOI: 10.1515/bmt-2022-0185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 06/07/2023] [Indexed: 06/24/2023]
Abstract
Transthoracic impedance is one of the key factors affecting the success of defibrillation. Impedance compensation technique is used to adjust defibrillation parameters according to the transthoracic impedance of the defibrillator. In this paper, a combined impedance compensation strategy is proposed to address the shortcomings of existing compensation strategies. In order to evaluate the performance of the combined compensation strategy, this paper uses the prototype as the experimental machine, and uses two AED with representative impedance compensation strategies as the control machine, and the simulated defibrillation method is used for comparative testing. The results show that the combined impedance compensation has a more steadier distribution over the defibrillation energy and current: compared with the energy-based impedance compensation strategy, this strategy can significantly reduce the peak current (25 Ω: 27.8 vs. 54.7 A; 50 Ω: 20.7 vs. 32.3 A) and average current (25 Ω: 24.8 vs. 37.5 A) of defibrillation at low impedance, and compared with the current impedance compensation strategy, it can significantly reduce the defibrillation energy (150 Ω: 8.6 vs. 1.7 %, 175 Ω: 15.6 vs. 4.9 %, 200 Ω: 21.9 vs. 8.5 %) at high impedance. Impedance compensation is more precise and the current passing during defibrillation is steadier.
Collapse
Affiliation(s)
- Qi Qi
- Unit for Drug and Instrument Supervision and Inspection of Wuxi Joint Logistic Support Center, PLA, Nanjing, China
| | - Ming Yu
- Medical Support Technology Research Department,Systems Engineering Institute, Academy of Military Sciences, PLA, Tianjin, China
| | - Jianhui Ge
- Unit for Drug and Instrument Supervision and Inspection of Wuxi Joint Logistic Support Center, PLA, Nanjing, China
| | - Chuanjun Li
- Unit for Drug and Instrument Supervision and Inspection of Wuxi Joint Logistic Support Center, PLA, Nanjing, China
| | - Guang Zhang
- Medical Support Technology Research Department,Systems Engineering Institute, Academy of Military Sciences, PLA, Tianjin, China
| | - Feng Chen
- Medical Support Technology Research Department,Systems Engineering Institute, Academy of Military Sciences, PLA, Tianjin, China
| |
Collapse
|
2
|
Rodio G, Iacopino S, Pisanò EC, Calvi V, Rovaris G, Marini M, Giammaria M, Caravati F, Maglia G, Zanotto G, Della Bella P, Biffi M, Curnis A, Maines M, Orsida D, Santamaria M, Bisignani G, Baroni M, Lissoni F, Duca A, Forleo GB, Piemontese C, De Salvia A, Miracapillo G, Celentano E, Zecchin M, Luzzi G, Giacopelli D, Gargaro A, D'Onofrio A. Temporal association between drops in thoracic impedance and malignant ventricular arrhythmia: A longitudinal analysis of remote monitoring trends. J Cardiovasc Electrophysiol 2023; 34:947-956. [PMID: 36709469 DOI: 10.1111/jce.15834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 12/23/2022] [Accepted: 01/22/2023] [Indexed: 01/30/2023]
Abstract
INTRODUCTION Thoracic impedance (TI) drops measured by implantable cardioverter-defibrillators (ICDs) have been reported to correlate with ventricular tachycardia/fibrillation (VT/VF). The aim of our study was to assess the temporal association of decreasing TI trends with VT/VF episodes through a longitudinal analysis of daily remote monitoring data from ICDs and cardiac resynchronization therapy defibrillators (CRT-Ds). METHODS AND RESULTS Retrospective data from 2384 patients were randomized 1:1 into a derivation or validation cohort. The TI decrease rate was defined as the percentage of rolling weeks with a continuously decreasing TI trend. The derivation cohort was used to determine a TI decrease rate threshold for a ≥99% specificity of arrhythmia prediction. The associated risk of VT/VF episodes was estimated in the validation cohort by dividing the available follow-up into 60-day assessment intervals. Analyses were performed separately for 1354 ICD and 1030 CRT-D patients. During a median follow-up of 2.0 years, 727 patients (30.4%) experienced 3298 confirmed VT/VF episodes. In the ICD group, a TI decrease rate of >60% was associated with a higher risk of VT/VF episode in a 60-day assessment interval (stratified hazard ratio, 1.42; 95% confidence interval (CI), 1.05-1.92; p = .023). The TI decrease preceded (40.8%) or followed (59.2%) the VT/VF episodes. In the CRT-D group, no association between TI decrease and VT/VF episodes was observed (p = .84). CONCLUSION In our longitudinal analysis, TI decrease was associated with VT/VF episodes only in ICD patients. Preventive interventions may be difficult since episodes can occur before or after TI decrease.
Collapse
Affiliation(s)
- Giovanna Rodio
- Division of Cardiology, Ospedale Santissima Annunziata, Taranto, Italy
| | | | | | - Valeria Calvi
- Azienda Ospedaliero Universitaria Policlinico "G.Rodolico - San Marco", Catania, Italy
| | | | | | | | | | | | | | | | - Mauro Biffi
- Policlinico Sant'Orsola-Malpighi, Bologna, Italy
| | | | | | | | | | | | - Matteo Baroni
- ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | | | | | | | | | | | | | | | | | - Giovanni Luzzi
- Division of Cardiology, Ospedale Santissima Annunziata, Taranto, Italy
| | - Daniele Giacopelli
- Biotronik Italia S.P.A., Vimodrone, Italy
- University of Padova, Padua, Italy
| | | | | |
Collapse
|
3
|
Rosenfeld LE. Using thoracic impedance to predict ventricular arrthythmia: Are the impediments insurmountable? J Cardiovasc Electrophysiol 2023; 34:957-958. [PMID: 36786517 DOI: 10.1111/jce.15858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 02/07/2023] [Indexed: 02/15/2023]
Affiliation(s)
- Lynda E Rosenfeld
- Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| |
Collapse
|
4
|
Zecchin M, Solimene F, D'Onofrio A, Zanotto G, Iacopino S, Pignalberi C, Calvi V, Maglia G, Della Bella P, Quartieri F, Curnis A, Biffi M, Capucci A, Caravati F, Senatore G, Santamaria M, Lissoni F, Manzo M, Marini M, Giammaria M, Rapacciuolo A, Sinagra G, Giacopelli D, Gargaro A, Pisanò EC. Atrial signal amplitude predicts atrial high-rate episodes in implantable cardioverter defibrillator patients: Insights from a large database of remote monitoring transmissions. J Arrhythm 2020; 36:353-362. [PMID: 32256887 PMCID: PMC7132187 DOI: 10.1002/joa3.12319] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 02/07/2020] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Parameters measured during implantable cardioverter defibrillator (ICD) implant also depend on bioelectrical properties of the myocardium. We aimed to explore their potential association with clinical outcomes in patients with single/dual-chamber ICD and cardiac resynchronization therapy defibrillator (CRT-D). METHODS In the framework of the Home Monitoring Expert Alliance, baseline electrical parameters for all implanted leads were compared by the occurrence of all-cause mortality, adjudicated ventricular arrhythmia (VA), and atrial high-rate episode lasting ≥24 hours (24 h AHRE). RESULTS In a cohort of 2976 patients (58.1% ICD) with a median follow-up of 25 months, event rates were 3.1/100 patient-years for all-cause mortality, 18.1/100 patient-years for VA, and 9.3/100 patient-years for 24 h AHRE. At univariate analysis, baseline shock impedance was consistently lower in groups with events than without, with a 40 Ω cutoff that better identified high-risk patients. However, at multivariable analysis, the adjusted-hazard ratios (HRs) lost statistical significance for any endpoint. Baseline atrial sensing amplitude during sinus rhythm was lower in patients with 24 h AHRE than in those without (2.45 [IQR: 1.65-3.85] vs 3.51 [IQR: 2.37-4.67] mV, P < .01). The adjusted HR for 24 h AHRE in patients with atrial sensing >1.5 mV vs those with values ≤1.5 mV was 0.52 (95% CI: 0.33-0.83), P = .006. CONCLUSIONS Although lower baseline shock impedance was observed in patients with events, the association lost statistical significance at multivariable analysis. Conversely, low sinus rhythm atrial sensing (≤1.5 mV) measured with standard transvenous leads could identify subjects at high risk of atrial arrhythmia.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Valeria Calvi
- Policlinico G. Rodolico, Az. O.U. Policlinico ‐ V. EmanueleCataniaItaly
| | | | | | | | | | - Mauro Biffi
- Policlinico Sant'Orsola‐MalpighiBolognaItaly
| | | | | | | | | | | | - Michele Manzo
- Azienda Ospedaliera Universitaria S.Giovanni di Dio e Ruggi D'AragonaSalernoItaly
| | | | | | | | | | | | | | | |
Collapse
|
5
|
Relationship between Atrial Tachyarrhythmias and Intrathoracic Impedance in Patients with a Pacemaker and Preserved Ejection Fraction. J Clin Med 2019; 9:jcm9010105. [PMID: 31906103 PMCID: PMC7020002 DOI: 10.3390/jcm9010105] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Revised: 12/22/2019] [Accepted: 12/29/2019] [Indexed: 11/17/2022] Open
Abstract
Atrial fibrillation (AF) is responsible for significant morbidity and mortality in patients with heart failure (HF). Modern pacemakers provide an index of intrathoracic fluid status (OptiVol fluid index-OVFI) by measuring daily intrathoracic impedance. This study aimed to determine whether OVFI is associated with increased atrial tachycardia/fibrillation (AT/AF) events in patients with a preserved ejection fraction (EF). We retrospectively reviewed data from patients with Medtronic Advisa pacemakers between 2012 and 2014 in our hospital. The association and temporal relationship between OVFI and AT/AF events were determined. A total of 150 patients with 211 follow-up visits (mean 1.4 visits per patient) were evaluated. The device-detected AT/AF prevalence was 47%. Device-measured OVFI ≥ 20 Ω-days was significantly associated with the onset of AT/AF ≥ 4 h. OVFI threshold crossing preceded AT/AF events in 55.1% of cases, followed by AT/AF events in only 18.7%. Fluid overload represented by OVFI may trigger AT/AF episodes in patients with a preserved EF more often than that previously reported in patients with a reduced EF. Our findings support the view that worsening pulmonary congestion is associated with increased AT/AF frequency and suggests that fluid overload could trigger and perpetuate AT/AF events in patients with a preserved EF.
Collapse
|
6
|
Abou Hassan OK, Refaat MM. Changes in intrathoracic impedance and episodes of ventricular arrhythmias in patients with heart failure and reduced ejection fraction. Pacing Clin Electrophysiol 2018; 41:1583-1584. [DOI: 10.1111/pace.13536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 10/22/2018] [Accepted: 10/23/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Ossama K. Abou Hassan
- Division of Cardiology; American University of Beirut Medical Center; Beirut Lebanon
| | - Marwan M. Refaat
- Division of Cardiology; American University of Beirut Medical Center; Beirut Lebanon
| |
Collapse
|
7
|
Osman M, Ahmed A, Alzubi H, Kheiri B, Osman K, Barbarawi M, Ríos-Bedoya CF, Bachuwa G, Hassan M. Association between changes in the intrathoracic impedance and ventricular arrhythmias in patients with heart failure. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2018; 41:1577-1582. [PMID: 30362185 DOI: 10.1111/pace.13535] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 07/21/2018] [Accepted: 08/04/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Ventricular arrhythmias (VAs) are independently related to mortality risk in patients with heart failure (HF). The wide availability of implantable cardioverter defibrillators and cardiac resynchronization therapy devices now offers an opportunity to clinically correlate the two disease processes. We hypothesized that there is an association between changes in the intrathoracic impedance and episodes of VA. METHODS Nonconcurrent prospective study of adults (age >20 years) with known HF with reduced ejection fraction (<35%). The OptiVol threshold was categorized as follows: 0-30 Ω-days, 31-60 Ω-days, 61-90 Ω-days, 91-120 Ω-days, and >120 Ω-days. Patients with OptiVol values at 0-30 Ω-days were used as the reference group. Receiver operating characteristic analysis was used to estimate the sensitivity and specificity at each threshold. RESULTS Of the 87 eligible patients, 65.5% were males. The mean age of the sample was 73.3 years (±12.7). Compared to patients in the 0-30 Ω-days category, those in the 31-60, 61-90, 91-120, and >120 Ω-days groups had, on average, 1.48, 1.64, 2.24, and 1.6 more VAs, respectively (P = 0.002, 0.009, 0.010 and 0.009, respectively). The sensitivity and specificity of each threshold were as follows: 82.6% and 61.7% at 31-60 Ω-days, 43.5% and 78.3% at 61-90 Ω-days, 30.4% and 85.0% at 91-120 Ω-days, and 21.7% and 88.3% at >121 Ω-days. CONCLUSION Our study found a significant positive relationship between changes in intrathoracic impedance and episodes of VAs in patients with HF.
Collapse
Affiliation(s)
- Mohammed Osman
- Internal Medicine Department, Hurley Medical Center/Michigan State University, Flint, MI, USA.,Division of Cardiology, Department of Medicine, West Virginia University School of Medicine, Morgantown, WV, USA
| | - Azza Ahmed
- Internal Medicine Department, Hurley Medical Center/Michigan State University, Flint, MI, USA
| | - Hussam Alzubi
- Internal Medicine Department, Hurley Medical Center/Michigan State University, Flint, MI, USA
| | - Babikir Kheiri
- Internal Medicine Department, Hurley Medical Center/Michigan State University, Flint, MI, USA
| | - Khansa Osman
- Faculty of Medicine, University of Khartoum, Khartoum, Sudan
| | - Mahmoud Barbarawi
- Internal Medicine Department, Hurley Medical Center/Michigan State University, Flint, MI, USA
| | - Carlos F Ríos-Bedoya
- Internal Medicine Department, Hurley Medical Center/Michigan State University, Flint, MI, USA
| | - Ghassan Bachuwa
- Internal Medicine Department, Hurley Medical Center/Michigan State University, Flint, MI, USA
| | - Mustafa Hassan
- Internal Medicine Department, Hurley Medical Center/Michigan State University, Flint, MI, USA
| |
Collapse
|
8
|
Abi-Saleh B. Water is a good electrical conductor! Int J Cardiol 2018; 262:64-65. [DOI: 10.1016/j.ijcard.2018.03.078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 03/15/2018] [Indexed: 10/17/2022]
|