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  • 1
    Electronic Resource
    Electronic Resource
    Pace-Termination and Pacing for Prevention of Atrial Tachyarrhythmias: Results from a Multicenter Study with an Implantable Device for Atrial Therapy (2001)
    Oxford, UK : Blackwell Science Inc
    Journal of cardiovascular electrophysiology 12 (2001), S. 0 
    Details
    ISSN: 1540-8167
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Pacing for Treatment of Atrial Tachyarrhythmias. Introduction: Patients with bradycardia requiring permanent pacing frequently suffer from additional atrial tachyarrhythmias (ATs). This study evaluated the safety and efficacy of atrial antitachycardia pacing (ATP) and the performance of pacing for AT prevention implemented into a new pacemaker. Methods and Results: In patients with conventional indications for permanent pacing, an investigational DDDRP pacemaker (Medtronic AT500, model 7253) was implanted. The primary study objectives were to determine the safety of overall device functioning and its efficacy in terminating spontaneous AT. A secondary endpoint was to determine the reliability of AT detection. Pacemaker memory functions were used to analyze the impact of dedicated pacing algorithms on AT prevention. In 33 European and Canadian centers, 325 patients were enrolled (mean follow-up 2.3 ± 1.3 months). Complication-free survival at 3 months was 88%. In 2,145 episodes stored with atrial electrograms, AT detection was confirmed in 97%. The algorithm for continuous overdrive pacing increased the percentage of atrial pacing to 97%. After ATP activation, 16,683 of 52,468 AT episodes were treated (120 patients). Of these, 8,903 episodes (53%) were terminated successfully by ATP. No proarrhythmic effect of preventive pacing or atrial ATP was observed. Preventive pacing algorithms increased the median percentage of atrial pacing from 62% to 97%. However, the number of AT/AF (atrial fibrillation) episodes (4.1 vs 4.1 per patient per day) and the time in AT/AF (13.7% vs 12.8%) was not significantly different before and after activation of preventive pacing. Conclusion: DDDRP pacing with a new system for AT therapy was safe and associated with successful pace-termination of AT in 53% of episodes. Preventive pacing and atrial ATP algorithms represent two new functions that can be implemented safely into pacemaker systems for nonpharmacologic treatment of ATs in patients requiring pacemaker therapy.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1046/j.1540-8167.2001.01121.x
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  • 2
    Electronic Resource
    Electronic Resource
    Subthreshold Test Pulses Versus Low Energy Shock Delivery to Estimate High Energy Lead Impedance in Implanted Cardioverter Defibrillator Patients (2003)
    350 Main Street , Malden , MA 02148-5018 , USA . : Blackwell Futura Publishing, Inc.
    Pacing and clinical electrophysiology 26 (2003), S. 0 
    Details
    ISSN: 1540-8159
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: VOLLMANN, D., et al.: Subthreshold Test Pulses Versus Low Energy Shock Delivery to Estimate High Energy Lead Impedance in Implanted Cardioverter Defibrillator Patients. The high energy lead impedance is valuable for detecting lead failure in ICDs, but until recently shock delivery was necessary for high energy impedance measurement. This study compared the use of subthreshold test pulses and low energy test shocks to estimate the high energy impedance. Immediately after implantation of Ventak Prizm ICDs in 29 patients, the lead impedance was measured with five subthreshold (0.4 μJ) test pulses, 5 low energy (1.1 J) shocks, and two to three high energy (16 ± 4.5 J) shocks. The mean impedances measured using high energy shocks, low energy shocks, and subthreshold pulses were 42.0 ± 7.3 Ω, 46.5 ± 8.1 Ω , and 42.4 ± 7.1 Ω , respectively. The impedances measured using high and low energy shocks differed significantly (P 〈0.0001) , while those obtained by high energy shocks and low energy pulses did not (P = 0.63) . According to the Pearson correlation coefficient, the impedance measurements with subthreshold pulses and low energy shocks were both closely correlated(P 〈 0.0001)with impedance values determined with high energy shocks. However, while the impedance values tended to be higher when measured with low energy shocks, the concordance correlation coefficient (c) was higher for subthreshold test pulse versus high energy shock(c = 0.92)than for low versus high energy shock(c = 0.73). Furthermore, the intraindividual variability of impedance measurements was lower with subthreshold pulse measurements than with low energy shocks. Compared with low energy shocks, impedance measurement with subthreshold pulses has higher reproducibility and a higher correlation with the impedance obtained by high energy shock delivery. Safe and painless high energy impedance estimation with subthreshold pulses might, therefore, help to detect ICD lead failure during routine follow-up. (PACE 2003; 26:[Pt. II]:457–460)
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1046/j.1460-9592.2003.00071.x
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  • 3
    Electronic Resource
    Electronic Resource
    Inhibition of Bradycardia Pacing and Detection of Ventricular Fibrillation Due to Far-Field Atrial Sensing in a Triple Chamber Implantable (2002)
    Oxford, UK : Blackwell Futura Publishing, Inc.
    Pacing and clinical electrophysiology 25 (2002), S. 0 
    Details
    ISSN: 1540-8159
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: VOLLMANN, D., et al.: Inhibition of Bradycardia Pacing and Detection of Ventricular Fibrillation Due to Far-Field Atrial Sensing in a Triple Chamber Implantable Cardioverter Defibrillator. Oversensing of intracardiac signals or myopotentials may cause inappropriate ICD therapy. Reports on far-field sensing of atrial signals are rare, and inappropriate ICD therapy due to oversensing of atrial fibrillation has not yet been described. This report presents a patient with a triple chamber ICD and a history of His-bundle ablation who experienced asystolic ventricular pauses and inappropriate detection of ventricular fibrillation due to far-field oversensing of atrial fibrillation. Several factors contributed to the complication, which resolved after reduction of the ventricular sensitivity.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1046/j.1460-9592.2002.01513.x
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  • 4
    Electronic Resource
    Electronic Resource
    Long-Term Clinical Experience with the EGM Width Detection Criterion for Differentiation of Supraventricular and Ventricular Tachycardia in Patients with Implantable Cardioverter Defibrillators (2000)
    Oxford, UK : Blackwell Futura Publishing, Inc.
    Pacing and clinical electrophysiology 23 (2000), S. 0 
    Details
    ISSN: 1540-8159
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: UNTERBERG, C., et al.: Long-Term Clinical Experience with the EGM Width Detection Criterion for Differentiation of Supraventricular and Ventricular Tachycardia in Patients with Implantable Cardioverter Defibrillators. Inappropriate therapy by ICDs due to SVTs is an important problem. A third generation ICD with a new detection criterion (“EGM width criterion”) for differentiation of SVTs and VTs by measuring the width of the intracardiac EGM was studied in 47 patients. A wide EGM was defined as the longest measured EGM plus 4–12 ms (programmed as EGM width threshold). EGM width detection function was programmed to the “Passive” mode so that no therapy was withheld. During a follow-up of 29.9 ± 8.3 (12–45) months, 489 spontaneous episodes were analyzed. SVTs occurred in ten patients with 305 episodes; 301 were correctly classified by use of the new detection criterion. In four patients four episodes were incorrectly detected as wide QRS tachycardias. Thus specificity for SVT was 98.7% (on a per episode basis) and 60% on a per patient basis. Of 184 VTs in 23 patients, 118 episodes were correctly classified (19 patients), however, in 4 patients 66 VTs were falsely detected as SVTs, 62 (94%) of which occurred in 1 patient with complete left BBB and continuously increasing QRS width in 12-lead surface ECGs. Overall sensitivity (on a per episode basis) for VT detection was 64.1% and 96.7% in patients with stable width of the QRS complex in a 12-lead surface ECG. These data show that this criterion is not superior to data on rate dependent detection criteria and furthermore not applicable in patients with complete BBB.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1046/j.1460-9592.2000.01611.x
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  • 5
    Electronic Resource
    Electronic Resource
    1-Year Performance of a Defibrillation Lead with a Small Electrode Surface for High Impedance Pacing: A Randomized, Controlled Study (2002)
    Oxford, UK : Blackwell Futura Publishing, Inc.
    Pacing and clinical electrophysiology 25 (2002), S. 0 
    Details
    ISSN: 1540-8159
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: VOLLMANN, D., et al.: 1-Year Performance of a Defibrillation Lead with a Small Electrode Surface for High Impedance Pacing: A Randomized, Controlled Study. A small electrode surface reduces pacing current drain and can extend generator longevity. The study evaluated the performance of a tined, quadripolar defibrillation lead (model 6944) that has a small-surfaced, steroid-eluting electrode tip for high impedance pacing. In a prospective, controlled study, 34 patients with conventional ICD indications were randomized one to one to receive the high impedance model 6944 or a tined defibrillation lead with a conventional sized, steroid-eluting electrode tip model 6942. Lead performance was evaluated at implant, prior to hospital discharge, and 1, 3, 6, and 12 months thereafter. Baseline characteristics did not differ significantly between patients implanted with lead model 6942 (n = 16) or model 6944 (n = 17). One patient randomized to receive the model 6942 was excluded from the study and was implanted with an active-fixation lead after stable lead positioning was neither possible with the 6942 nor with the 6944 electrode. No other lead related adverse events were observed. At implant, there were no significant differences between pacing thresholds, sensing performance, defibrillation impedances, and defibrillation thresholds in both groups, but pacing impedance of the model 6944 (988.6 ± 217.7 Ω) was approximately twice as high as in the model 6942 (431.7 ± 83.7 Ω; P 〈 0.0001). This difference remained highly significant throughout the observation period of 12 months, while R wave amplitudes and pacing thresholds remained equal in both lead models. The use of a tined defibrillation lead with a small, steroid-eluting electrode tip appears safe and results in a high pacing impedance without compromising system performance.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1046/j.1460-9592.2002.01577.x
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  • 6
    Electronic Resource
    Electronic Resource
    Early Detection of Lead Fracture by Painless High Voltage Lead Impedance Measurement in a Transvenous ICD Lead System (2000)
    Springer
    Journal of interventional cardiac electrophysiology 4 (2000), S. 269-272 
    Details
    ISSN: 1572-8595
    Keywords: ICD lead fracture ; painless lead impedance ; early detection
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract We report the case of a 69 year old patient, who underwent transvenous implantable cardioverter defibrillator (ICD) device change (Medtronic GEM VR 7227 Cx Active Can) because the ICD reached its replacement indicators. Preoperative chest X-ray and intraoperative defibrillation threshold tests and high voltage impedance did not show lead fracture of the five year old lead (Transvene 6936-65). At the second postoperative day the alarm of the newly implanted ICD device was activated because of high impedance in the painless lead impedance measurement (PLI) and the lead was replaced. The explanted lead showed a fracture detectable only by PLI.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1023/A:1009886117378
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