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Quantification of Electromechanical Coupling to Prevent Inappropriate Implantable Cardioverter-Defibrillator Shocks

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Title: Quantification of Electromechanical Coupling to Prevent Inappropriate Implantable Cardioverter-Defibrillator Shocks
Authors: Keene, D
Shun-Shin, M
Arnold, A
Howard, J
Lefroy, D
Davies, W
Lim, PB
Ng, FS
Koa-Wing, M
Qureshi, N
Linton, N
Shah, J
Peters, N
Kanagaratnam, P
Francis, D
Whinnett, Z
Item Type: Journal Article
Abstract: Objective To test specialised processing of laser Doppler signals for discriminating ventricular fibrillation(VF) from common causes of inappropriate therapies. Background Inappropriate ICD therapies remain a clinically important problem associated with morbidity and mortality. Tissue perfusion biomarkers, to assist automated diagnosis of VF, suffer the vulnerability of sometimes mistaking artefact and random noise for perfusion, which could lead to shocks being inappropriately withheld. Methods We developed a novel processing algorithm that combines electrogram data and laser Doppler perfusion monitoring, as a method for assessing circulatory status. We recruited 50 patients undergoing VF induction during ICD implantation. We recorded non-invasive laser Doppler and continuous electrograms, during both sinus-rhythm and VF. For each patient we simulated two additional scenarios that may lead to inappropriate shocks: ventricular-lead fracture and T-wave oversensing. We analysed the laser Doppler using three methods for reducing noise: (i)Running Mean, (ii)Oscillatory Height, (iii)a novel quantification of Electro-Mechanical coupling which gates laser Doppler against electrograms. We additionally tested the algorithm during exercise induced sinus tachycardia. Results Only the Electro-mechanical coupling algorithm found a clear perfusion cut-off between sinus rhythm and VF (sensitivity and specificity 100%). Sensitivity and specificity remained 100% during simulated lead fracture and electrogram oversensing. (AUC: Running Mean 0.91, Oscillatory Height 0.86, Electro-Mechanical Coupling 1.00). Sinus tachycardia did not cause false positives. Conclusions Quantifying the coupling between electrical and perfusion signals increases reliability of discrimination between VF and artefacts that ICDs may interpret as VF. Incorporating such methods into future ICDs may safely permit reductions of inappropriate shocks.
Issue Date: Jun-2019
Date of Acceptance: 17-Jan-2019
URI: http://hdl.handle.net/10044/1/67165
DOI: https://doi.org/10.1016/j.jacep.2019.01.025
ISSN: 2405-500X
Publisher: Elsevier
Start Page: 705
End Page: 715
Journal / Book Title: JACC: Clinical Electrophysiology
Volume: 5
Issue: 6
Copyright Statement: Crown Copyright © 2019. Published by Elsevier on behalf of the American College of Cardiology Foundation. This an open access article distributed under the terms of the Creative Commons Attribution 4.0 International license ( https://creativecommons.org/licenses/by/4.0/ ).
Sponsor/Funder: British Heart Foundation
Foundation for Circulatory Health
British Heart Foundation
British Heart Foundation
British Heart Foundation
Imperial College Healthcare NHS Trust- BRC Funding
British Heart Foundation
Funder's Grant Number: FS/13/44/30291
Keywords: arrhythmia discrimination
hemodynamic monitoring
implantable cardioverter-defibrillator
inappropriate therapy
laser Doppler perfusion monitoring
Publication Status: Published
Online Publication Date: 2019-03-27
Appears in Collections:Bioengineering
National Heart and Lung Institute
Faculty of Engineering