Reducing ICD Test Shocks with a Simplified Upper Limit of Vulnerability.
Background Determination of an adequate defibrillation safety margin or defibrillation threshold can be a challenge in patients with implantable defibrillators (ICDs). The upper limit of vulnerability (ULV) has been shown to be highly correlated with measured defibrillation thresholds. The peak of t...
| Publicado en: | Pacing & Clinical Electrophysiology Vol. 39; no. 7; pp. 652 - 658 |
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| Autores principales: | , , |
| Formato: | algorithm research tables/charts tracings Journal Article |
| Publicado: |
Wiley-Blackwell
Jul2016
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=116618030&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 116618030 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 01478389 4F8 jtl: Pacing & Clinical Electrophysiology issn: 01478389 maglogo: Y pubinfo: dt: Jul2016 vid: 39 iid: 7 pid: 480 pub: Wiley-Blackwell place: Malden, Massachusetts artinfo: ui: 116618030 116618030 116618030 10.1111/pace.12863 116618030 ppf: 652 ppct: 6 formats: fmt: – @attributes: type: T – @attributes: type: P tig: atl: Reducing ICD Test Shocks with a Simplified Upper Limit of Vulnerability. aug: au: PITTARO, MICHAEL DEFORGE, WILLIAM KROLL, MARK W. affil: Norwalk Hospital, Norwalk Connecticut sug: subj: Defibrillators, Implantable Evaluation Cardiac Resynchronization Therapy Equipment and Supplies Cardiac Patients Statistics and Numerical Data Human Electrocardiography Algorithms Male Female Middle Age Aged Aged, 80 and Over Adult T-Tests Descriptive Statistics Data Analysis Software Middle Aged: 45-64 years Aged: 65+ years Aged, 80 & over Adult: 19-44 years Male Female ab: Background Determination of an adequate defibrillation safety margin or defibrillation threshold can be a challenge in patients with implantable defibrillators (ICDs). The upper limit of vulnerability (ULV) has been shown to be highly correlated with measured defibrillation thresholds. The peak of the latest peaking monophasic T wave measured from the pacing spike of the induction train of S1 via the surface electrocardiogram (ECG) is generally accepted to approximate the vulnerable period of the cardiac cycle. Objectives The purpose of this study was to determine whether a single electrogram-derived coupling interval could provide an accurate determination of the vulnerable period for a simplified test method to approximate the defibrillation safety margin. Methods We used a single electrogram-derived coupling interval for the timing of the T shock. We compared the measured intracardiac electrogram coupling interval to the latest peaking T wave on the surface ECG. Results A total of 72 patients were studied: single-chamber ICD (n = 28), dual-chamber ICD (n = 26), or cardiac resynchronization therapy-defibrillator (n = 18). The coupling intervals were greater on the electrograms versus the surface ECG: 365 ms ± 27 versus 347 ms ± 26 (P < 0.0001). Almost all of the patients tested, 69/72 (96%), were indeed defibrillated with the T-shock energy that failed to induce ventricular fibrillation (VF). Only three (4%) of the patients failed the hypothesis when 500 V failed to induce VF but subsequently also failed to defibrillate a forced induction of VF. Conclusions A simplified ULV testing protocol, using a single electrogram channel, accurately separates low from high defibrillation threshold testing patients. pubtype: Academic Journal doctype: algorithm research tables/charts tracings Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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