PMID- 24532110
OWN - NLM
STAT- MEDLINE
DCOM- 20150105
LR  - 20211021
IS  - 1572-8595 (Electronic)
IS  - 1383-875X (Linking)
VI  - 39
IP  - 3
DP  - 2014 Apr
TI  - Incidence of nonphysiologic short VV intervals detected by the sensing integrity 
      counter with integrated bipolar compared with true bipolar leads: clinically 
      inconsequential or cause for concern?
PG  - 281-5
LID - 10.1007/s10840-013-9866-7 [doi]
AB  - INTRODUCTION: The need to detect impending implantable cardiac defibrillator 
      (ICD) lead failure has grown. Automated sensing diagnostics have been developed 
      for this reason. The sensing integrity counter (SIC) is one such oversensing 
      diagnostic, which forms an integral part of the Medtronic lead integrity alert 
      (LIA) feature on implantable defibrillators. It records nonphysiologic short VV 
      intervals (NPSVVIs). It is unclear whether SIC data derived from integrated 
      bipolar (IBP) leads need to be interpreted differently when compared to true 
      bipolar (TBP) leads. We hypothesized that IBP ICD leads by virtue of a larger 
      "antennae" may generate more NPSVVIs on than TBP leads, leading to more 
      false-positive SIC counts. METHODS: Equal durations of remote monitoring records 
      of 44 patients (mean age of 65.9 +/- 2.2 years, 52 % female) with IBP ICD leads and 
      Medtronic (MDT) generators (IBP group) were compared with those of 44 randomly 
      selected patients (64.0 +/- 2.2 years, 24 % female) who had TBP ICD leads and MDT 
      generators (TBP group). Mean surveillance time, defined as the time over which 
      the cumulative SIC count was acquired, was 614 +/- 44 days (TBP group) vs. 620 +/- 49 
      days (IBP group, p = ns). The mean time of follow-up following the first 
      documented short VV interval was 115.2 months in the integrated bipolar group and 
      66.9 months in the true bipolar group. Leads on advisory were excluded from the 
      study. RESULTS: A total of 26/44 patients in the IBP group displayed NPSVVI 
      compared to 11/44 patients in the TBP group (59 vs. 25 %; p = 0.002, Fisher exact 
      test). When adjusted for gender and lead age, the difference was still 
      significant (p = 0.008). When evaluating the clinical consequence of NPSVVI in 
      this cohort, 3/11 TBP leads with NPSVVI of >0 were eventually extracted due to 
      additional abnormalities vs. 0/26 IBP leads with NPSVVI (p = 0.02, Fisher exact 
      test). None of the IBP group patients with NPSVVI have developed inappropriate 
      therapy from lead noise or a need for abandonment or extraction. CONCLUSION: 
      Integrated bipolar ICD leads are more likely to have elevated SIC counts than 
      true bipolar leads despite revealing no other evidence of lead failure. There 
      does not appear to be a need for heightened surveillance in IBP leads with 
      observed elevated SIC counts that have no other findings to suggest lead 
      malfunction.
FAU - Ng, Justin
AU  - Ng J
AD  - Brigham and Women's Hospital, Boston, MA, USA, jng123456@gmail.com.
FAU - Chopra, Nagesh
AU  - Chopra N
FAU - Barbhaiya, Chirag
AU  - Barbhaiya C
FAU - Reichlin, Tobias
AU  - Reichlin T
FAU - Nof, Eyal
AU  - Nof E
FAU - Nagashima, Koichi
AU  - Nagashima K
FAU - Tadros, Thomas
AU  - Tadros T
FAU - Koplan, Bruce A
AU  - Koplan BA
LA  - eng
PT  - Comparative Study
PT  - Journal Article
DEP - 20140216
PL  - Netherlands
TA  - J Interv Card Electrophysiol
JT  - Journal of interventional cardiac electrophysiology : an international journal of 
      arrhythmias and pacing
JID - 9708966
SB  - IM
MH  - Aged
MH  - *Defibrillators, Implantable
MH  - Equipment Design
MH  - Equipment Failure Analysis/*methods
MH  - Female
MH  - Humans
MH  - Male
EDAT- 2014/02/18 06:00
MHDA- 2015/01/06 06:00
CRDT- 2014/02/18 06:00
PHST- 2013/08/21 00:00 [received]
PHST- 2013/12/04 00:00 [accepted]
PHST- 2014/02/18 06:00 [entrez]
PHST- 2014/02/18 06:00 [pubmed]
PHST- 2015/01/06 06:00 [medline]
AID - 10.1007/s10840-013-9866-7 [doi]
PST - ppublish
SO  - J Interv Card Electrophysiol. 2014 Apr;39(3):281-5. doi: 
      10.1007/s10840-013-9866-7. Epub 2014 Feb 16.