Quantification of Electromechanical Coupling to Prevent Inappropriate Implantable Cardioverter-Defibrillator Shocks.
Aged
Algorithms
Defibrillators, Implantable
Electric Countershock
Electrocardiography
Electrophysiologic Techniques, Cardiac
Equipment Failure
Exercise
Female
Humans
Laser-Doppler Flowmetry
Male
Middle Aged
Sensitivity and Specificity
Signal Processing, Computer-Assisted
Tachycardia, Sinus
Ventricular Fibrillation
/ diagnosis
arrhythmia discrimination
hemodynamic monitoring
implantable cardioverter-defibrillator
inappropriate therapy
laser Doppler perfusion monitoring
Journal
JACC. Clinical electrophysiology
ISSN: 2405-5018
Titre abrégé: JACC Clin Electrophysiol
Pays: United States
ID NLM: 101656995
Informations de publication
Date de publication:
06 2019
06 2019
Historique:
received:
14
11
2018
revised:
10
01
2019
accepted:
17
01
2019
entrez:
22
6
2019
pubmed:
22
6
2019
medline:
17
9
2020
Statut:
ppublish
Résumé
This study sought to test specialized processing of laser Doppler signals for discriminating ventricular fibrillation (VF) from common causes of inappropriate therapies. Inappropriate implantable cardioverter-defibrillator (ICD) therapies remain a clinically important problem associated with morbidity and mortality. Tissue perfusion biomarkers, implemented to assist automated diagnosis of VF, sometimes mistake artifacts and random noise for perfusion, which could lead to shocks being inappropriately withheld. The study tested a novel processing algorithm that combines electrogram data and laser Doppler perfusion monitoring as a method for assessing circulatory status. Fifty patients undergoing VF induction during ICD implantation were recruited. Noninvasive laser Doppler and continuous electrograms were recorded during both sinus rhythm and VF. Two additional scenarios that might have led to inappropriate shocks were simulated for each patient: ventricular lead fracture and T-wave oversensing. The laser Doppler was analyzed using 3 methods for reducing noise: 1) running mean; 2) oscillatory height; and 3) a novel quantification of electromechanical coupling which gates laser Doppler relative to electrograms. In addition, the algorithm was tested during exercise-induced sinus tachycardia. Only the electromechanical coupling algorithm found a clear perfusion cut off between sinus rhythm and VF (sensitivity and specificity of 100%). Sensitivity and specificity remained at 100% during simulated lead fracture and electrogram oversensing. (Area under the curve running mean: 0.91; oscillatory height: 0.86; electromechanical coupling: 1.00). Sinus tachycardia did not cause false positive results. Quantifying the coupling between electrical and perfusion signals increases reliability of discrimination between VF and artifacts that ICDs may interpret as VF. Incorporating such methods into future ICDs may safely permit reductions of inappropriate shocks.
Sections du résumé
OBJECTIVES
This study sought to test specialized processing of laser Doppler signals for discriminating ventricular fibrillation (VF) from common causes of inappropriate therapies.
BACKGROUND
Inappropriate implantable cardioverter-defibrillator (ICD) therapies remain a clinically important problem associated with morbidity and mortality. Tissue perfusion biomarkers, implemented to assist automated diagnosis of VF, sometimes mistake artifacts and random noise for perfusion, which could lead to shocks being inappropriately withheld.
METHODS
The study tested a novel processing algorithm that combines electrogram data and laser Doppler perfusion monitoring as a method for assessing circulatory status. Fifty patients undergoing VF induction during ICD implantation were recruited. Noninvasive laser Doppler and continuous electrograms were recorded during both sinus rhythm and VF. Two additional scenarios that might have led to inappropriate shocks were simulated for each patient: ventricular lead fracture and T-wave oversensing. The laser Doppler was analyzed using 3 methods for reducing noise: 1) running mean; 2) oscillatory height; and 3) a novel quantification of electromechanical coupling which gates laser Doppler relative to electrograms. In addition, the algorithm was tested during exercise-induced sinus tachycardia.
RESULTS
Only the electromechanical coupling algorithm found a clear perfusion cut off between sinus rhythm and VF (sensitivity and specificity of 100%). Sensitivity and specificity remained at 100% during simulated lead fracture and electrogram oversensing. (Area under the curve running mean: 0.91; oscillatory height: 0.86; electromechanical coupling: 1.00). Sinus tachycardia did not cause false positive results.
CONCLUSIONS
Quantifying the coupling between electrical and perfusion signals increases reliability of discrimination between VF and artifacts that ICDs may interpret as VF. Incorporating such methods into future ICDs may safely permit reductions of inappropriate shocks.
Identifiants
pubmed: 31221358
pii: S2405-500X(19)30146-X
doi: 10.1016/j.jacep.2019.01.025
pmc: PMC6597902
pii:
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
705-715Subventions
Organisme : British Heart Foundation
ID : FS/13/44/30291
Pays : United Kingdom
Organisme : British Heart Foundation
ID : FS/15/25/31423
Pays : United Kingdom
Organisme : British Heart Foundation
ID : RG/16/3/32175
Pays : United Kingdom
Organisme : British Heart Foundation
ID : FS/15/53/31615
Pays : United Kingdom
Commentaires et corrections
Type : CommentIn
Informations de copyright
Crown Copyright © 2019. Published by Elsevier Inc. All rights reserved.
Références
Technol Health Care. 1999;7(2-3):143-62
pubmed: 10463304
Lasers Med Sci. 2009 Mar;24(2):269-83
pubmed: 18236103
J Am Coll Cardiol. 2008 Apr 8;51(14):1357-65
pubmed: 18387436
Am J Physiol Heart Circ Physiol. 2008 Dec;295(6):H2560-72
pubmed: 18849335
J Cardiovasc Electrophysiol. 2010 Apr;21(4):448-54
pubmed: 19845814
J Am Coll Cardiol. 2011 Feb 1;57(5):556-62
pubmed: 21272746
Pacing Clin Electrophysiol. 2012 Aug;35(8):919-26
pubmed: 22553955
Heart Rhythm. 2012 Oct;9(10):1585-91
pubmed: 22561598
N Engl J Med. 2012 Dec 13;367(24):2275-83
pubmed: 23131066
JAMA Intern Med. 2013 May 27;173(10):859-65
pubmed: 23546173
JAMA. 2013 May 8;309(18):1903-11
pubmed: 23652522
J Cardiothorac Vasc Anesth. 2014 Oct;28(5):1211-6
pubmed: 25125374
Pacing Clin Electrophysiol. 2014 Oct;37(10):1315-23
pubmed: 25139346
Can J Cardiol. 2015 Mar;31(3):270-7
pubmed: 25746019
Arrhythm Electrophysiol Rev. 2016 Aug;5(2):110-6
pubmed: 27617089
Circ Cardiovasc Qual Outcomes. 2017 Feb;10(2):
pubmed: 28196927
J Interv Card Electrophysiol. 2017 Sep;49(3):271-280
pubmed: 28730420
Heart Rhythm. 2018 Oct;15(10):1515-1522
pubmed: 29758404