PMID- 16635998
OWN - NLM
STAT- MEDLINE
DCOM- 20061020
LR  - 20061115
IS  - 1099-5129 (Print)
IS  - 1099-5129 (Linking)
VI  - 8
IP  - 5
DP  - 2006 May
TI  - Patient Alert to detect ICD lead failure: efficacy, limitations, and implications 
      for future algorithms.
PG  - 371-6
AB  - AIMS: An algorithm that alerts implantable cardioverter-defibrillator (ICD) 
      patients, in case of abnormal lead impedance (Patient Alerttrade mark, 
      Medtronic), may help to recognize lead dysfunction. We aimed to determine the 
      utility of Patient Alert for ICD lead-failure detection in a prospective study. 
      METHODS AND RESULTS: Three hundred and sixty ICD patients were followed for 
      22+/-14 months. Patient Alert was active for pacing impedance <200 and >2000-3000 
      Omega, and high-voltage conductor impedance <10-20 and >200 Omega. Ten alert 
      events and a total of 29 severe system complications occurred. Patient Alert 
      detected three of 10 ICD lead failures, with a positive predictive value (PPV) of 
      77.8% for any severe system complication. Retrospective analysis identified 23 
      patients with a sensing integrity counter (SIC) >300 and revealed an additional 
      four prior undetected lead defects. SIC detected ICD lead failure with 92.9% 
      sensitivity and a PPV of 59.1%. Eight of nine patients with a false-positive SIC 
      had an integrated bipolar lead. Patient Alert combined with SIC detected all ICD 
      lead failures and 71.4% of all severe lead complications. CONCLUSIONS: Patient 
      Alert, based on daily lead-impedance measurement, detected one-third of all ICD 
      lead failures. Combined use with continuous lead integrity monitoring (SIC) 
      increased sensitivity to 100%. Integrated bipolar leads may yield a 
      false-positive SIC. Incorporating SIC and automated pace/sense threshold 
      measurement may improve Patient Alert sensitivity for severe lead complications.
FAU - Vollmann, Dirk
AU  - Vollmann D
AD  - Abteilung Kardiologie und Pneumologie, Herzzentrum, Georg-August-Universitat 
      Gottingen, Germany. dirkvollmann2000@aol.com
FAU - Erdogan, Ali
AU  - Erdogan A
FAU - Himmrich, Ewald
AU  - Himmrich E
FAU - Neuzner, Jorg
AU  - Neuzner J
FAU - Becker, Daniel
AU  - Becker D
FAU - Unterberg-Buchwald, Christina
AU  - Unterberg-Buchwald C
FAU - Sperzel, Johannes
AU  - Sperzel J
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PL  - England
TA  - Europace
JT  - Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal 
      of the working groups on cardiac pacing, arrhythmias, and cardiac cellular 
      electrophysiology of the European Society of Cardiology
JID - 100883649
SB  - IM
MH  - Aged
MH  - *Algorithms
MH  - *Defibrillators, Implantable
MH  - Electric Impedance
MH  - Equipment Failure
MH  - Equipment Safety
MH  - False Positive Reactions
MH  - Female
MH  - Humans
MH  - Male
MH  - Predictive Value of Tests
MH  - Prospective Studies
MH  - Sensitivity and Specificity
EDAT- 2006/04/26 09:00
MHDA- 2006/10/21 09:00
CRDT- 2006/04/26 09:00
PHST- 2006/04/26 09:00 [pubmed]
PHST- 2006/10/21 09:00 [medline]
PHST- 2006/04/26 09:00 [entrez]
AID - 8/5/371 [pii]
AID - 10.1093/europace/eul023 [doi]
PST - ppublish
SO  - Europace. 2006 May;8(5):371-6. doi: 10.1093/europace/eul023.