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Interpreting device diagnostics for lead failure.

Charles D Swerdlow1, Sylvain Ploux2, Jeanne E Poole3

  • 1Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California.

Heart Rhythm
|October 1, 2021
PubMed
Summary
This summary is machine-generated.

Implantable cardioverter-defibrillators (ICDs) use alerts to detect lead failure (LF). New analysis reviews alert types, electrograms, and impedance trends for improved lead monitoring and patient safety.

Keywords:
Implantable cardioverter-defibrillatorLead diagnosticsLead dysfunctionLead failurePacemaker

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Area of Science:

  • Biomedical Engineering
  • Cardiology
  • Medical Device Technology

Background:

  • Implantable cardioverter-defibrillators (ICDs) utilize automated alerts for lead monitoring to detect lead failure (LF).
  • Current alerts have limitations in detecting partial fractures and require specific conditions for high-impedance or insulation breach detection.
  • Oversensing and impedance trends offer additional diagnostic information beyond triggered alerts.

Purpose of the Study:

  • To review the characteristics, advantages, and limitations of various ICD lead-monitoring alerts.
  • To analyze electrogram (EGM) findings associated with lead fractures.
  • To evaluate the diagnostic utility of impedance trends in detecting lead failure and connection issues.

Main Methods:

  • Review of existing literature on ICD lead-monitoring alerts and diagnostics.
  • Analysis of electrogram (EGM) characteristics in leads with confirmed fractures and insulation breaches.
  • Examination of impedance trend patterns and their correlation with lead integrity and connection status.

Main Results:

  • Partial conductor fractures can cause oversensing, while high-impedance alerts typically detect only complete fractures.
  • Oversensing alerts identify specific interval patterns but can be nonspecific; sensing/shock channel comparison offers implementation-dependent performance.
  • Impedance trend analysis provides valuable insights, with abrupt increases often indicating header issues or lead failure, despite alert insensitivity.

Conclusions:

  • Understanding the nuances of different ICD alerts and diagnostics is crucial for accurate lead failure detection.
  • Electrogram analysis and impedance trend monitoring complement triggered alerts, enhancing diagnostic capabilities.
  • Improved discrimination between connection issues and lead failure is essential for optimal patient management.