Multicenter investigation of an implantable cardioverter-defibrillator algorithm to detect oversensing

Nicolas Welte; Marc Strik; Romain Eschalier; Pierre Mondoly; Pascal Defaye; Antonio Frontera; Philippe Ritter; Michel Haissaguerre; Sylvain Ploux; Jayanthi Koneru; Kenneth A. Ellenbogen; Pierre Bordachar

doi:10.1016/j.hrthm.2017.03.023

Multicenter investigation of an implantable cardioverter-defibrillator algorithm to detect oversensing

Nicolas Welte, Marc Strik^*, Romain Eschalier, Pierre Mondoly, Pascal Defaye, Antonio Frontera, Philippe Ritter, Michel Haissaguerre, Sylvain Ploux, Jayanthi Koneru, Kenneth A. Ellenbogen, Pierre Bordachar

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

BACKGROUND The SecureSense right ventricular (RV) lead noise discrimination algorithm is designed to detect lead fracture and other types of oversensing in order to decrease inappropriate therapy.

OBJECTIVE We studied the real-life accuracy of the SecureSense algorithm in implantable cardioverter-defibrillator (ICD) patients followed by remote monitoring across multiple centers.

METHODS Across 3 French centers, we studied 486 patients with a St Jude Medical device who were followed by remote monitoring and who had the SecureSense algorithm activated. We reviewed

RESULTS SecureSense inhibited 22 inappropriate therapies (lead dysfunction in 10 cases, P-wave oversensing in 12 cases). A total of 57 patients (12%) sent >= 1 nonsustained oversensing episode (total of 393 episodes) with multiple etiologies: noise on the near-field channel (38%), oversensing of T waves during ventricular pacing (33%), oversensing of the sinus P wave (12%), and oversensing of the paced P wave (6%). Two episodes (0.5%) of nonsustained VT were undersensed by the far-field channel. Of 336 analyzed episodes of ventricular tachyarrhythmia, 15 episodes (4%) in 4 patients were related to oversensing of intrinsic P waves in 11 episodes or oversensing of external noise due to electrical cautery for the remaining 4 episodes.

CONCLUSION Of ICD patients equipped with SecureSense, 12% developed episodes of oversensing. The SecureSense algorithm prevented inappropriate ICD therapies with accurate diagnosis of oversensing (caused by lead dysfunction or oversensing of physiological signals). P-wave oversensing in integrated bipolar leads, electrical cautery, and electromagnetic interference are prone to be missed by SecureSense.

Original language	English
Pages (from-to)	1008-1015
Number of pages	8
Journal	Heart Rhythm
Volume	14
Issue number	7
DOIs	https://doi.org/10.1016/j.hrthm.2017.03.023
Publication status	Published - Jul 2017

Keywords

Algorithm
Devices
Electrogram
Implantable cardioverter-defibrillator
Noise
SecureSense
St Jude Medical
Ventricular fibrillation
Ventricular tachycardia
SHOCKS
PERFORMANCE
FAILURE
NOISE

Access to Document

10.1016/j.hrthm.2017.03.023

Cite this

@article{e66872404ab24013868925c9215ca476,

title = "Multicenter investigation of an implantable cardioverter-defibrillator algorithm to detect oversensing",

abstract = "BACKGROUND The SecureSense right ventricular (RV) lead noise discrimination algorithm is designed to detect lead fracture and other types of oversensing in order to decrease inappropriate therapy.OBJECTIVE We studied the real-life accuracy of the SecureSense algorithm in implantable cardioverter-defibrillator (ICD) patients followed by remote monitoring across multiple centers.METHODS Across 3 French centers, we studied 486 patients with a St Jude Medical device who were followed by remote monitoring and who had the SecureSense algorithm activated. We reviewedRESULTS SecureSense inhibited 22 inappropriate therapies (lead dysfunction in 10 cases, P-wave oversensing in 12 cases). A total of 57 patients (12%) sent >= 1 nonsustained oversensing episode (total of 393 episodes) with multiple etiologies: noise on the near-field channel (38%), oversensing of T waves during ventricular pacing (33%), oversensing of the sinus P wave (12%), and oversensing of the paced P wave (6%). Two episodes (0.5%) of nonsustained VT were undersensed by the far-field channel. Of 336 analyzed episodes of ventricular tachyarrhythmia, 15 episodes (4%) in 4 patients were related to oversensing of intrinsic P waves in 11 episodes or oversensing of external noise due to electrical cautery for the remaining 4 episodes.CONCLUSION Of ICD patients equipped with SecureSense, 12% developed episodes of oversensing. The SecureSense algorithm prevented inappropriate ICD therapies with accurate diagnosis of oversensing (caused by lead dysfunction or oversensing of physiological signals). P-wave oversensing in integrated bipolar leads, electrical cautery, and electromagnetic interference are prone to be missed by SecureSense.",

keywords = "Algorithm, Devices, Electrogram, Implantable cardioverter-defibrillator, Noise, SecureSense, St Jude Medical, Ventricular fibrillation, Ventricular tachycardia, SHOCKS, PERFORMANCE, FAILURE, NOISE",

author = "Nicolas Welte and Marc Strik and Romain Eschalier and Pierre Mondoly and Pascal Defaye and Antonio Frontera and Philippe Ritter and Michel Haissaguerre and Sylvain Ploux and Jayanthi Koneru and Ellenbogen, {Kenneth A.} and Pierre Bordachar",

year = "2017",

month = jul,

doi = "10.1016/j.hrthm.2017.03.023",

language = "English",

volume = "14",

pages = "1008--1015",

journal = "Heart Rhythm",

issn = "1547-5271",

publisher = "Elsevier Science",

number = "7",

}

TY - JOUR

T1 - Multicenter investigation of an implantable cardioverter-defibrillator algorithm to detect oversensing

AU - Welte, Nicolas

AU - Strik, Marc

AU - Eschalier, Romain

AU - Mondoly, Pierre

AU - Defaye, Pascal

AU - Frontera, Antonio

AU - Ritter, Philippe

AU - Haissaguerre, Michel

AU - Ploux, Sylvain

AU - Koneru, Jayanthi

AU - Ellenbogen, Kenneth A.

AU - Bordachar, Pierre

PY - 2017/7

Y1 - 2017/7

N2 - BACKGROUND The SecureSense right ventricular (RV) lead noise discrimination algorithm is designed to detect lead fracture and other types of oversensing in order to decrease inappropriate therapy.OBJECTIVE We studied the real-life accuracy of the SecureSense algorithm in implantable cardioverter-defibrillator (ICD) patients followed by remote monitoring across multiple centers.METHODS Across 3 French centers, we studied 486 patients with a St Jude Medical device who were followed by remote monitoring and who had the SecureSense algorithm activated. We reviewedRESULTS SecureSense inhibited 22 inappropriate therapies (lead dysfunction in 10 cases, P-wave oversensing in 12 cases). A total of 57 patients (12%) sent >= 1 nonsustained oversensing episode (total of 393 episodes) with multiple etiologies: noise on the near-field channel (38%), oversensing of T waves during ventricular pacing (33%), oversensing of the sinus P wave (12%), and oversensing of the paced P wave (6%). Two episodes (0.5%) of nonsustained VT were undersensed by the far-field channel. Of 336 analyzed episodes of ventricular tachyarrhythmia, 15 episodes (4%) in 4 patients were related to oversensing of intrinsic P waves in 11 episodes or oversensing of external noise due to electrical cautery for the remaining 4 episodes.CONCLUSION Of ICD patients equipped with SecureSense, 12% developed episodes of oversensing. The SecureSense algorithm prevented inappropriate ICD therapies with accurate diagnosis of oversensing (caused by lead dysfunction or oversensing of physiological signals). P-wave oversensing in integrated bipolar leads, electrical cautery, and electromagnetic interference are prone to be missed by SecureSense.

AB - BACKGROUND The SecureSense right ventricular (RV) lead noise discrimination algorithm is designed to detect lead fracture and other types of oversensing in order to decrease inappropriate therapy.OBJECTIVE We studied the real-life accuracy of the SecureSense algorithm in implantable cardioverter-defibrillator (ICD) patients followed by remote monitoring across multiple centers.METHODS Across 3 French centers, we studied 486 patients with a St Jude Medical device who were followed by remote monitoring and who had the SecureSense algorithm activated. We reviewedRESULTS SecureSense inhibited 22 inappropriate therapies (lead dysfunction in 10 cases, P-wave oversensing in 12 cases). A total of 57 patients (12%) sent >= 1 nonsustained oversensing episode (total of 393 episodes) with multiple etiologies: noise on the near-field channel (38%), oversensing of T waves during ventricular pacing (33%), oversensing of the sinus P wave (12%), and oversensing of the paced P wave (6%). Two episodes (0.5%) of nonsustained VT were undersensed by the far-field channel. Of 336 analyzed episodes of ventricular tachyarrhythmia, 15 episodes (4%) in 4 patients were related to oversensing of intrinsic P waves in 11 episodes or oversensing of external noise due to electrical cautery for the remaining 4 episodes.CONCLUSION Of ICD patients equipped with SecureSense, 12% developed episodes of oversensing. The SecureSense algorithm prevented inappropriate ICD therapies with accurate diagnosis of oversensing (caused by lead dysfunction or oversensing of physiological signals). P-wave oversensing in integrated bipolar leads, electrical cautery, and electromagnetic interference are prone to be missed by SecureSense.

KW - Algorithm

KW - Devices

KW - Electrogram

KW - Implantable cardioverter-defibrillator

KW - Noise

KW - SecureSense

KW - St Jude Medical

KW - Ventricular fibrillation

KW - Ventricular tachycardia

KW - SHOCKS

KW - PERFORMANCE

KW - FAILURE

KW - NOISE

U2 - 10.1016/j.hrthm.2017.03.023

DO - 10.1016/j.hrthm.2017.03.023

M3 - Article

SN - 1547-5271

VL - 14

SP - 1008

EP - 1015

JO - Heart Rhythm

JF - Heart Rhythm

IS - 7

ER -