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Herzschrittmachertherapie + Elektrophysiologie

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01.09.2021 | Original Contributions

Potential of remote monitoring to prevent sensing and detection failures in implantable cardioverter defibrillators

verfasst von: Tobias Franz Götz, MD, Jochen Proff, Tobias Timmel, Clemens Jilek, Klaus Tiemann, Thorsten Lewalter

Erschienen in: Herzschrittmachertherapie + Elektrophysiologie | Ausgabe 1/2022

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Abstract

Background

Sensing malfunction and misinterpretation of intracardiac electrograms (IEGMs) in patients with implantable cardioverter defibrillators (ICDs) may lead to inadequate device activity such as inappropriate shock delivery or unnecessary mode-switching. Remote monitoring has the potential for early detection of sensing malfunction or misclassification and may thus prevent adverse device activity. Therefore, the authors analyzed the amount, nature, and distribution of misclassification in current ICD and cardiac resynchronization therapy defibrillator technology using the device transmissions of the IN-TIME study population.

Methods

All transmitted tachyarrhythmic episodes in the 664 IN-TIME patients, comprising 2214 device-classified atrial fibrillation (DC-AF) episodes lasting ≥ 30 s and 1330 device-classified ventricular tachycardia or fibrillation (DC-VT/VF) episodes, were manually analyzed by two experienced cardiologists.

Results

After evaluation of all DC-VT/VF episodes, a total of 300 VT/VF events (23.1%) were false-positive, with supraventricular tachycardia being the most frequent cause (51.7%), followed by atrial fibrillation (21.3%) and T‑wave oversensing (21.0%). A total of 15 patients with false-positive DC-VT/VF received inappropriate shocks. According to the inclusion criteria, 616 IEGMs with DC-AF were assessed. A total of 19.7% were false-positive AF episodes and R‑wave oversensing was the most common reason (55.9%).

Conclusions

Remote monitoring offers the opportunity of early detection of signal misclassification and thus early prevention of adverse device reaction, such as inappropriate shock delivery or mode-switching with intermittent loss of atrioventricular synchrony, by correcting the underlying causes.

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Titel: Potential of remote monitoring to prevent sensing and detection failures in implantable cardioverter defibrillators
verfasst von: Tobias Franz Götz, MD
Jochen Proff
Tobias Timmel
Clemens Jilek
Klaus Tiemann
Thorsten Lewalter
Publikationsdatum: 01.09.2021
Verlag: Springer Medizin
Erschienen in: Herzschrittmachertherapie + Elektrophysiologie / Ausgabe 1/2022
Print ISSN: 0938-7412
Elektronische ISSN: 1435-1544
DOI: https://doi.org/10.1007/s00399-021-00802-2

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Potential of remote monitoring to prevent sensing and detection failures in implantable cardioverter defibrillators

Abstract

Background

Methods

Results

Conclusions

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Live-Webinar: Aktuelle Leitlinien bei Herz-Kreislauf-Erkrankungen

Springer Medizin

Abstract

Background

Methods

Results

Conclusions

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