Automated detection of effective left-ventricular pacing: going beyond percentage pacing counters.
Aims: Cardiac resynchronization therapy (CRT) devices report percentage pacing as a diagnostic but cannot determine the effectiveness of each paced beat in capturing left-ventricular (LV) myocardium. Reasons for ineffective LV pacing include improper timing (i.e. pseudofusion) or inadequate pacing o...
| Published in: | EP: Europace Vol. 17; no. 10; pp. 1555 - 1563 |
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| Main Authors: | , , |
| Format: | Journal Article |
| Published: |
Oxford University Press / USA
Oct2015
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| Online Access: | View this record in EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=110579551&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 110579551 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 10995129 NYF jtl: EP: Europace issn: 10995129 maglogo: N pubinfo: dt: Oct2015 vid: 17 iid: 10 pid: 622 pub: Oxford University Press / USA artinfo: ui: 110579551 110579551 NLM25862307 10.1093/europace/euv062 NLM25862307 PMC4617370 110579551 ppf: 1555 ppct: 8 formats: tig: atl: Automated detection of effective left-ventricular pacing: going beyond percentage pacing counters. aug: au: Ghosh, Subham Stadler, Robert W. Mittal, Suneet affil: Medtronic Inc., 8200 Coral Sea St, Mounds View, MN 55112, USA sug: subj: Algorithms Cardiac Resynchronization Therapy Heart Failure Therapy Heart Ventricle Physiopathology Pacemaker, Artificial Adverse Effects Male Aged Female Middle Age Arthritis Impact Measurement Scales Aged: 65+ years Middle Aged: 45-64 years Male Female ab: Aims: Cardiac resynchronization therapy (CRT) devices report percentage pacing as a diagnostic but cannot determine the effectiveness of each paced beat in capturing left-ventricular (LV) myocardium. Reasons for ineffective LV pacing include improper timing (i.e. pseudofusion) or inadequate pacing output. Device-based determination of effective LV pacing may facilitate optimization of CRT response.Methods and Results: Effective capture at the LV cathode results in a negative deflection (QS or QS-r morphology) on a unipolar electrogram (EGM). Morphological features of LV cathode-RV coil EGMs were analysed to develop a device-based automatic algorithm, which classified each paced beat as effective or ineffective LV pacing. The algorithm was validated using acute data from 28 CRT-defibrillator patients. Effective LV pacing and pseudofusion was simulated by pacing at various AV delays. Loss of LV capture was simulated by RV-only pacing. The algorithm always classified LV or biventricular (BV) pacing with AV delays ≤60% of patient's intrinsic AV delay as effective pacing. As AV delays increased, the percentage of beats classified as effective LV pacing decreased. Algorithm results were compared against a classification truth based on correlation coefficients between paced QRS complexes and intrinsic rhythm QRS templates from three surface ECG leads. An average correlation >0.9 defined a classification truth of ineffective pacing. Compared against the classification truth, the algorithm correctly classified 98.2% (3240/3300) effective LV pacing beats, 75.8% (561/740) of pseudofusion beats, and 100% (540/540) of beats with loss of LV capture.Conclusion: A device-based algorithm for beat-by-beat monitoring of effective LV pacing is feasible. pubtype: Academic Journal doctype: Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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