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 language | English |
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Pages (from-to) | 1125-1134 |
Number of pages | 10 |
Journal | Journal of Cardiovascular Electrophysiology |
Volume | 29 |
Issue number | 8 |
DOIs | |
Publication status | Published - 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