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PubMed2003

Electromagnetic interference by transcutaneous neuromuscular electrical stimulation in patients with bipolar sensing implantable cardioverter defibrillators: a pilot safety study.

Neuromuscular electrical stimulation (NMES) is a frequently applied therapy for the treatment of pain and a therapeutic option to increase thigh muscle strength and endurance capacity in patients with heart failure. Electromagnetic interference (EMI) by the signals with sensing of ICDs is possible. Eight patients with subpectoral ICD systems and different transvenous bipolar sensing leads were subjected to electrical stimulation of the neck and shoulder and of the thighs using different stimulation algorithms. EMI with ventricular sensing was detectable in three of eight subjects. EMI occurred during stimulation of the neck (n = 2) and thigh (n = 2). EMI by NMES with atrial sensing was seen in two of four subjects with dual chamber ICDs. The safety of peripheral NMES has to be individually tested as EMI can also occur in ICD patients with bipolar sensing.

Adult↗
PubMed2003

R wave undersensing caused by an algorithm intended to enhance sensing specificity in an implantable cardioverter defibrillator.

This article reports on a case of ventricular undersensing despite normal R wave amplitudes during sinus rhythm in an ICD patient. Undersensing of ventricular signals was noted without any evidence of lead dislocation or variation in signal amplitude. Undersensing was due to an exceptionally small R wave signal width and a feature of the Biotronik sensing algorithm designed to avoid oversensing. This algorithm, intended to enhance the sensing specificity of the device, requires registration of two consecutive points above the maximum programmed sensitivity for a ventricular sense event. After modifying the algorithm to a single point registration undersensing disappeared.

Aged↗
PubMed2003

Incidence and characteristics of type-2 breaks in response to antitachycardia pacing therapy in implantable cardioverter defibrillator patients.

INTRODUCTION: Antitachycardia pacing (ATP) effectively treats monomorphic ventricular tachycardia (VT). The VT may cease immediately upon ATP completion (type-1 break), or it may persist or change to another tachyarrhythmia for one or more beats before termination (type-2 break). We investigated the prevalence and characteristics of type-2 breaks in ICD patients. METHODS AND RESULTS: We analyzed VT episodes with stored electrograms that had at least one ATP therapy delivered in PainFREE Rx trial, a multicenter trial with 220 coronary artery disease patients. Further subanalysis was performed by classifying the VT as slow or fast based on the cycle length (CL); slow VT: CL >320 ms, fast VT: 240 < or =CL < or =320 ms. To assess the effect of ATP on VT, comparison was performed of pre-ATP and post-ATP CL variability, average CL, and morphology. A total of 514 episodes (264 slow VT and 250 fast VT) were analyzed. The burst ATP terminated 457 (89%; 239 slow VT and 218 fast VT) of 514 episodes. Forty five (10%) episodes in 18 (32%) patients had type-2 breaks. The mean number of beats during type-2 breaks was 5.4 +/- 3.1 (median 4). The mean time for episode termination measured from the end of ATP to return of first sinus/paced beat was 2.9 +/- 1.2 seconds (median 2.6). The VT CL variability increased by 150% after ATP delivery. The ATP affected either VT CL or morphology, or both of 36 (80%) type-2 breaks (9% accelerated, 47% decelerated, 22% changed in morphology only). Among the 9 (20%) episodes that remained unchanged in morphology and CL, four episodes (9%) were unaffected by ATP. CONCLUSION: Approximately 10% of VT episodes that were successfully terminated with burst ATP therapy had type-2 breaks. Type-2 breaks are associated with an increase in CL variability. Approximately 9% of all type-2 episodes may be spontaneously terminating nonsustained VT given that ATP did not affect these episodes in any way.

Cardiac Pacing, Artificial↗