The Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
J Am Coll Cardiol. 2011 Jun 7;57(23):2330-9. doi: 10.1016/j.jacc.2010.12.042.
This study sought to use implantable cardioverter-defibrillator (ICD) diagnostics to discriminate ICD lead fractures from normally functioning leads with high impedance and from connection problems between the lead and header.
ICD diagnostics facilitate identification of fractures, but there are no accepted criteria for discriminating fractures from other causes of high impedance and/or nonphysiological "noise" oversensing.
We analyzed a development set of 91 leads to construct a stepwise algorithm based on ICD diagnostics. It included 40 fractures, 30 connection problems, and 21 functioning leads that triggered high-impedance alerts. Then we applied this algorithm to an independent test set of 100 leads: 70 fractures and 30 intact leads with connection problems that were misdiagnosed clinically as fractures. In the algorithm, either extremely high maximum impedance or noise oversensing with a normal impedance trend indicated a fracture. A short interval from surgery to impedance rise or prolonged stable impedance after an abrupt rise indicated a connection problem. A gradual impedance increase or stable, high impedance indicated a functioning lead.
In the test set, the algorithm correctly classified 100% of fractures (95% confidence interval [CI]: 95% to 100%) and 87% of connection problems that were misdiagnosed as fractures (95% CI: 70% to 95%).
An algorithm using only ICD diagnostics identifies leads with oversensing or high impedance as fractures or connection problems with a high degree of accuracy.
本研究旨在利用植入式心脏复律除颤器（ICD）诊断来区分 ICD 导联的骨折与具有高阻抗的正常工作导联以及导联与头端之间的连接问题。
ICD 诊断有助于识别骨折，但尚无区分骨折与其他高阻抗和/或非生理“噪声”过感原因的公认标准。
我们分析了一组 91 根导联，以构建基于 ICD 诊断的逐步算法。它包括 40 个骨折，30 个连接问题，以及 21 个触发高阻抗警报的正常工作导联。然后，我们将该算法应用于一组 100 根导联的独立测试集：70 个骨折和 30 个连接问题的完整导联，这些导联在临床上被误诊为骨折。在算法中，极高的最大阻抗或正常阻抗趋势下的噪声过感表明存在骨折。从手术到阻抗升高的短间隔或突然升高后稳定的阻抗表明存在连接问题。逐渐升高的阻抗或稳定的高阻抗表明是正常工作的导联。
在测试集中，该算法正确分类了 100%的骨折（95%置信区间[CI]：95%至 100%）和 87%被误诊为骨折的连接问题（95%CI：70%至 95%）。
仅使用 ICD 诊断的算法可高度准确地识别具有过感或高阻抗的导联是骨折或连接问题。
