Brisben Amy J, Burke Martin C, Knight Bradley P, Hahn Stephen J, Herrmann Keith L, Allavatam Venugopal, Mahajan Deepa, Sanghera Rick, Gold Michael R
Boston Scientific Corporation, St. Paul, Minnesota, USA.
Section of Cardiology, Department of Internal Medicine, University of Chicago, Chicago, Illinois, USA.
J Cardiovasc Electrophysiol. 2015 Apr;26(4):417-423. doi: 10.1111/jce.12612. Epub 2015 Feb 17.
The subcutaneous ICD system (S-ICD) has been shown to be a safe and effective treatment for patients at risk for sudden cardiac death. This device reliably detects ventricular tachyarrhythmias with a low incidence of inappropriate shocks for supraventricular arrhythmias. However, T-wave oversensing (TWOS) is more common with the S-ICD compared with transvenous systems. We developed a novel discrimination algorithm to reduce TWOS without compromising tachyarrhythmia discrimination.
The algorithm was developed using a database of recorded episodes, including 244 appropriate therapies for ventricular arrhythmias and 133 episodes with an inappropriate detection due to TWOS, and using a computer model that simulates the S-ICD system. An independent set of data of 161 TWOS episodes, 137 ventricular and 328 supraventricular episodes, was used to validate the algorithm on actual device hardware. The S-ICD performance with the new algorithm was compared with the S-ICD without the new algorithm. Development results showed a decrease in inappropriate charge due to TWOS by 30.7 ± 18%. All ventricular arrhythmias were appropriately detected and the time to appropriate charge initiation was not increased. System validation showed that the new algorithm avoided an inappropriate charge due to TWOS by 39.8 ± 11.4%. No decrease in ventricular arrhythmia sensitivity and no significant change in supraventricular specificity were observed.
A new algorithm that uses correlation of the existing complex to previous complexes reduced TWOS episodes by approximately 40%. The algorithm has potential for a clinically meaningful decrease in inappropriate shocks.
皮下植入式心律转复除颤器系统（S-ICD）已被证明是一种治疗心脏性猝死风险患者的安全有效方法。该设备能可靠地检测室性快速心律失常，对室上性心律失常进行不适当电击的发生率较低。然而，与经静脉系统相比，S-ICD的T波过度感知（TWOS）更为常见。我们开发了一种新的鉴别算法，以减少TWOS，同时不影响快速心律失常的鉴别。
该算法是利用一个记录事件数据库开发的，该数据库包括244次针对室性心律失常的适当治疗以及133次因TWOS导致的不适当检测事件，并使用了一个模拟S-ICD系统的计算机模型。一组独立的数据，包括161次TWOS事件、137次室性事件和328次室上性事件，用于在实际设备硬件上验证该算法。将采用新算法的S-ICD性能与未采用新算法的S-ICD进行比较。开发结果显示，因TWOS导致的不适当充电减少了30.7±18%。所有室性心律失常均被适当检测到，且适当充电启动时间未增加。系统验证表明，新算法避免了因TWOS导致的不适当充电，比例为39.8±11.4%。未观察到室性心律失常敏感性降低，室上性特异性也无显著变化。
一种利用现有复合波与先前复合波相关性的新算法使TWOS事件减少了约40%。该算法有可能在临床上显著减少不适当电击。
