Towards eradication of inappropriate therapies for ICD lead failure by combining comprehensive remote monitoring and lead noise alerts

Sylvain Ploux*, Charles D. Swerdlow, Marc Strik, Nicolas Welte, Nicolas Klotz, Philippe Ritter, Michel Haissaguerre, Pierre Bordachar

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

8 Citations (Web of Science)

Abstract

IntroductionRecognition of implantable cardioverter defibrillator (ICD) lead malfunction before occurrence of life threatening complications is crucial. We aimed to assess the effectiveness of remote monitoring associated or not with a lead noise alert for early detection of ICD lead failure. MethodsFrom October 2013 to April 2017, a median of 1,224 (578-1,958) ICD patients were remotely monitored with comprehensive analysis of all transmitted materials. ICD lead failure and subsequent device interventions were prospectively collected in patients with (RMLN) and without (RM) a lead noise alert (Abbott Secure Sense or Medtronic Lead Integrity Alert) in their remote monitoring system. ResultsDuring a follow-up of 4,457 patient years, 64 lead failures were diagnosed. Sixty-one (95%) of the diagnoses were made before any clinical complication occurred. Inappropriate shocks were delivered in only one patient of each group (3%), with an annual rate of 0.04%. All high voltage conductor failures were identified remotely by a dedicated impedance alert in 10 patients. Pace-sense component failures were correctly identified by a dedicated alert in 77% (17 of 22) of the RMLN group versus 25% (8 of 32) of the RM group (P=0.002). The absence of a lead noise alert was associated with a 16-fold increase in the likelihood of initiating either a shock or ATP (OR: 16.0, 95% CI 1.8-143.3; P=0.01). ConclusionICD remote monitoring with systematic review of all transmitted data is associated with a very low rate of inappropriate shocks related to lead failure. Dedicated noise alerts further reduce inappropriate detection of ventricular arrhythmias.
Original languageEnglish
Pages (from-to)1125-1134
Number of pages10
JournalJournal of Cardiovascular Electrophysiology
Volume29
Issue number8
DOIs
Publication statusPublished - 1 Aug 2018

Keywords

  • implantable cardioverter defibrillator
  • inappropriate shock
  • inappropriate therapy
  • lead failure
  • lead noise algorithm
  • remote monitoring
  • telemedicine
  • CARDIOVERTER-DEFIBRILLATOR LEAD
  • EXPERT CONSENSUS STATEMENT
  • FAR-FIELD ELECTROGRAMS
  • SHOCKS
  • FRACTURES
  • ALGORITHM
  • MANAGEMENT
  • IMPACT

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