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Quantitative Autonomic Testing

Quantitative Autonomic Testing

Published on: July 19, 2011

Automated vulnerability testing identifies patients with inadequate defibrillation safety margin.

Ulrika Birgersdotter-Green¹, Linda L Ruetz, Kishlay Anand

¹University of California San Diego, San Diego, CA, USA. ubgreen@ucsd.edu

Circulation. Arrhythmia and Electrophysiology

|October 12, 2012

Summary

This study tested an automated system for implantable cardioverter-defibrillator testing, reducing the need for induced ventricular fibrillation (VF). The system successfully identified patients needing adjustments, proving feasible for safer, more efficient defibrillator implantation.

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Utilizing Percutaneous Ventricular Assist Devices in Acute Myocardial Infarction Complicated by Cardiogenic Shock

Utilizing Percutaneous Ventricular Assist Devices in Acute Myocardial Infarction Complicated by Cardiogenic Shock

Published on: June 12, 2021

Area of Science:

Cardiovascular Medicine
Biomedical Engineering
Medical Device Technology

Background:

Implantable cardioverter-defibrillator (ICD) systems require efficacy testing at implantation, typically via induced ventricular fibrillation (VF).
Assessing defibrillation safety margins without VF induction is possible using upper limits of vulnerability, but historically required manual T-wave timing.
Manual T-wave timing is a limitation in current defibrillation safety margin assessments.

Purpose of the Study:

To evaluate the feasibility of an inductionless system for implant testing of ICDs.
To assess an automated vulnerability safety margin system that measures T-wave timing.
To determine if automated testing can reduce the need for VF induction during ICD implantation.

Main Methods:

A multicenter prospective study enrolled 60 patients undergoing ICD implantation.
An automated system measured T-wave timing via intracardiac electrogram during ventricular pacing, delivering up to 4 T-wave shocks.
Lack of VF induction by the automated system was considered adequate; patients then underwent conventional defibrillation testing.

Main Results:

The automated system tested 54 patients, inducing VF in 10 (19%), with 2 requiring system revision.
All patients not induced by the automated system were successfully defibrillated at ≤25 J.
Bayesian statistics indicated a 97% to 100% credible interval for defibrillation success at 25 J in non-induced patients.

Conclusions:

The automated system effectively identified patients failing conventional safety margin testing while minimizing VF induction.
This automated approach shows feasibility for reducing the need for VF induction in ICD implant testing.
Further studies with larger sample sizes are warranted to confirm these findings.