Haut-Lévêque Hospital, Centre Hospitalier Universitaire de Bordeaux, LIRYC Institute, Pessac, France.
Haut-Lévêque Hospital, Centre Hospitalier Universitaire de Bordeaux, LIRYC Institute, Pessac, France; Maastricht University Medical Center, Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands.
Heart Rhythm. 2017 Jul;14(7):1008-1015. doi: 10.1016/j.hrthm.2017.03.023. Epub 2017 Mar 18.
The SecureSense right ventricular (RV) lead noise discrimination algorithm is designed to detect lead fracture and other types of oversensing in order to decrease inappropriate therapy.
We studied the real-life accuracy of the SecureSense algorithm in implantable cardioverter-defibrillator (ICD) patients followed by remote monitoring across multiple centers.
Across 3 French centers, we studied 486 patients with a St Jude Medical device who were followed by remote monitoring and who had the SecureSense algorithm activated. We reviewed ≤10 of the most recent remote monitoring-transmitted electrograms of nonsustained oversensing, RV lead noise, and ventricular tachycardia/ventricular fibrillation that received therapy.
SecureSense inhibited 22 inappropriate therapies (lead dysfunction in 10 cases, P-wave oversensing in 12 cases). A total of 57 patients (12%) sent ≥1 nonsustained oversensing episode (total of 393 episodes) with multiple etiologies: noise on the near-field channel (38%), oversensing of T waves during ventricular pacing (33%), oversensing of the sinus P wave (12%), and oversensing of the paced P wave (6%). Two episodes (0.5%) of nonsustained VT were undersensed by the far-field channel. Of 336 analyzed episodes of ventricular tachyarrhythmia, 15 episodes (4%) in 4 patients were related to oversensing of intrinsic P waves in 11 episodes or oversensing of external noise due to electrical cautery for the remaining 4 episodes.
Of ICD patients equipped with SecureSense, 12% developed episodes of oversensing. The SecureSense algorithm prevented inappropriate ICD therapies with accurate diagnosis of oversensing (caused by lead dysfunction or oversensing of physiological signals). P-wave oversensing in integrated bipolar leads, electrical cautery, and electromagnetic interference are prone to be missed by SecureSense.
SecureSense 右心室（RV）导联噪声判别算法旨在检测导联断裂和其他类型的过感知，以减少不适当的治疗。
我们研究了SecureSense 算法在植入式心脏复律除颤器（ICD）患者中的实际准确性，这些患者通过远程监测在多个中心进行随访。
在 3 个法国中心，我们研究了 486 名接受远程监测且激活了 SecureSense 算法的 St Jude Medical 设备患者。我们回顾了 22 例因 RV 导联噪声和室性心动过速/心室颤动而接受治疗的非持续过感知、RV 导联噪声和室性心动过速/心室颤动的最近远程监测传输的电描记图中的≤10 例。
SecureSense 抑制了 22 例不适当的治疗（10 例为导联功能障碍，12 例为 P 波过感知）。共有 57 例（12%）患者发送了≥1 次非持续过感知发作（共 393 次发作），有多种病因：近场通道噪声（38%）、心室起搏时 T 波过感知（33%）、窦性 P 波过感知（12%）和起搏 P 波过感知（6%）。远场通道对 2 次（0.5%）非持续 VT 发作漏感。在 336 次分析的室性心动过速/颤动发作中，4 例患者的 15 次发作（4%）与 11 次固有 P 波过感知或 4 次因电灼术导致的外部噪声有关。
在配备 SecureSense 的 ICD 患者中，有 12%发生了过感知发作。SecureSense 算法通过对过感知（由导联功能障碍或生理信号过感知引起）的准确诊断，防止了不适当的 ICD 治疗。集成双极导联中的 P 波过感知、电灼术和电磁干扰易被 SecureSense 漏诊。
