ABSTRACT
Patients with implantable cardioverter defibrillator lead insulation failures may present with oversensing and/or abnormal impedance. The Lead Integrity Alert (LIA) monitors right ventricular pace/sense leads using both continuous oversensing and daily impedance measurementd. Oversensing consists of isolated short R-R intervals and nonsustained runs of short R-R intervals. The LIA algorithm has been studied for Sprint Fidelis conductor fractures, but not for lead insulation failures. We report on a patient with a failed St. Jude Riata™ ST lead (St. Jude Medical, St. Paul, MN, USA) connected to a Medtronic Virtuoso DR (Medtronic Inc., Minneapolis, MN, USA) with the LIA. Oversensing triggered the LIA, while the impedance trend was normal.
Subject(s)
Clinical Alarms , Defibrillators, Implantable/adverse effects , Electric Injuries/etiology , Electrocardiography, Ambulatory/instrumentation , Electrocardiography, Ambulatory/methods , Electrodes, Implanted/adverse effects , Equipment Failure , Algorithms , Electric Conductivity , Electric Injuries/prevention & control , Humans , Male , Young AdultABSTRACT
AIMS: To evaluate a novel atrial lead designed to reduce far-field sensing. METHODS AND RESULTS: Sixty-three patients with standard pacing indications were randomized to receive an OptiSense 1699T (St Jude Medical, USA) or conventional pacing lead in the right atrium. Post-implant follow-up was conducted for all patients at 90 days and for a subset at 360 days. Standard electrical parameters were measured. Thresholds of sensing were determined for far-field ventricular signals. The number of inappropriate mode switches was determined from the stored intracardiac electrogram (IEGM). At 90 days, an IEGM Holter recorded 24 h of IEGM. With atrial sensitivity programmed at 0.3 mV, no far-field sensing occurred in the OptiSense group, but it did occur in 20% and 30% of the control group at 90 and 360 days, respectively. Inappropriate mode switching was observed in 4% of the OptiSense group in contrast to 23% of the control group. The IEGM Holter found no far-field sensing in the OptiSense group, but did find 83 023 far-field events from 22% of control patients. The standard electrical parameters of the OptiSense leads were acceptable. CONCLUSION: The OptiSense lead reduced ventricular far-field sensing in the atrium while maintaining satisfactory pacing and sensing performance, resulting in less inappropriate mode switch.
