Accurate Detection of Lead Malfunction From ECG-derived Bipolar Pacing Stimulus Amplitude.
ECG
insulation
malfunction
pacemaker leads
pseudo-unipolarization
stimulus
Journal
Heart rhythm
ISSN: 1556-3871
Titre abrégé: Heart Rhythm
Pays: United States
ID NLM: 101200317
Informations de publication
Date de publication:
02 Apr 2024
02 Apr 2024
Historique:
received:
27
02
2024
revised:
21
03
2024
accepted:
29
03
2024
medline:
5
4
2024
pubmed:
5
4
2024
entrez:
4
4
2024
Statut:
aheadofprint
Résumé
One common mode of lead failure is insulation breach which may result in myopotential noise and device malfunction. "Pseudo-unipolarization" of bipolar pacing stimuli, as observed from a routine 12-lead ECG due to stimulus current leak has been observed with insulation breaches. We sought to characterize this ECG finding to detect lead this type of lead malfunction. 138 transvenous leads were analyzed, including 88 with known malfunction and 50 normal leads. The amplitude of a bipolar pacing stimulus on ECG was recorded and compared to a control dataset of newly implanted leads with bipolar stimuli normalized for output. The malfunction group consisted of 61% RA and 39% RV leads with mean pacing output 2.74V at 0.5ms. There was a significant difference in ECG bipolar stimulus amplitudes at time of identification of failure (7.89 ± 7.56mm per V, p<0.001) compared to those of normal leads (0.86 ± 0.41mm per V). ROC curve for the prediction of lead malfunction based on absolute EKG amplitude displayed an area under curve of 0.93 (95% CI 0.891- 0.969). When normalized for programmed stimulus output, a cutoff of 5mm/V demonstrated a sensitivity of 91% and a specificity of 92% (AUC 0.967 95% CI 0.938-0.996). The maximum amplitude of a bipolar pacing stimulus on ECG is significantly lower in normal functioning leads compared to those with known malfunction. This simply-derived variable demonstrated good accuracy at identifying lead failure due to insulation breach.
Sections du résumé
BACKGROUND
BACKGROUND
One common mode of lead failure is insulation breach which may result in myopotential noise and device malfunction. "Pseudo-unipolarization" of bipolar pacing stimuli, as observed from a routine 12-lead ECG due to stimulus current leak has been observed with insulation breaches.
OBJECTIVE
OBJECTIVE
We sought to characterize this ECG finding to detect lead this type of lead malfunction.
METHODS
METHODS
138 transvenous leads were analyzed, including 88 with known malfunction and 50 normal leads. The amplitude of a bipolar pacing stimulus on ECG was recorded and compared to a control dataset of newly implanted leads with bipolar stimuli normalized for output.
RESULTS
RESULTS
The malfunction group consisted of 61% RA and 39% RV leads with mean pacing output 2.74V at 0.5ms. There was a significant difference in ECG bipolar stimulus amplitudes at time of identification of failure (7.89 ± 7.56mm per V, p<0.001) compared to those of normal leads (0.86 ± 0.41mm per V). ROC curve for the prediction of lead malfunction based on absolute EKG amplitude displayed an area under curve of 0.93 (95% CI 0.891- 0.969). When normalized for programmed stimulus output, a cutoff of 5mm/V demonstrated a sensitivity of 91% and a specificity of 92% (AUC 0.967 95% CI 0.938-0.996).
CONCLUSION
CONCLUSIONS
The maximum amplitude of a bipolar pacing stimulus on ECG is significantly lower in normal functioning leads compared to those with known malfunction. This simply-derived variable demonstrated good accuracy at identifying lead failure due to insulation breach.
Identifiants
pubmed: 38574791
pii: S1547-5271(24)02309-9
doi: 10.1016/j.hrthm.2024.03.1814
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
Copyright © 2024. Published by Elsevier Inc.