J M Lillo-Castellano1, Manuel Marina-Breysse2, Alfonso Gómez-Gallanti3, J B Martínez-Ferrer4, Javier Alzueta5, Luisa Pérez-Álvarez6, Arcadi Alberola7, Ignacio Fernández-Lozano8, Anibal Rodríguez9, Rosa Porro10, Ignacio Anguera11, Adolfo Fontenla12, J J González-Ferrer13, Victoria Cañadas-Godoy13, Nicasio Pérez-Castellano13, Daniel Garófalo3, Óscar Salvador-Montañés3, Conrado J Calvo14, Jorge G Quintanilla15, Rafael Peinado3, Inmaculada Mora-Jiménez16, Julián Pérez-Villacastín13, J L Rojo-Álvarez16, David Filgueiras-Rama15. 1. Myocardial Pathophysiology Area, Fundación Centro Nacional de Investigaciones Cardiovasculares, Carlos III (CNIC), Madrid, Spain Department of Signal Theory and Communications, Telematics and Computing, Universidad Rey Juan Carlos (URJC), Madrid, Spain. 2. Myocardial Pathophysiology Area, Fundación Centro Nacional de Investigaciones Cardiovasculares, Carlos III (CNIC), Madrid, Spain. 3. Department of Cardiology, Hospital Universitario La Paz, Madrid, Spain. 4. Department of Cardiology, Hospital Universitario de Araba, Vitoria, Spain. 5. Department of Cardiology, Hospital Universitario Virgen de la Victoria, Málaga, Spain. 6. Department of Cardiology, Hospital Universitario A Coruña, La Coruña, Spain. 7. Department of Cardiology, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain. 8. Department of Cardiology, Hospital Universitario Puerta de Hierro, Madrid, Spain. 9. Department of Cardiology, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain. 10. Department of Cardiology, Hospital San Pedro de Alcántara, Cáceres, Spain. 11. Department of Cardiology, Hospital de Bellvitge, Barcelona, Spain. 12. Department of Cardiology, Hospital 12 de Octubre, Madrid, Spain. 13. Department of Cardiology, Hospital Clínico San Carlos, Madrid, Spain. 14. Myocardial Pathophysiology Area, Fundación Centro Nacional de Investigaciones Cardiovasculares, Carlos III (CNIC), Madrid, Spain Department of Electrical Engineering, Universitat Politècnica de Valencia, Valencia, Spain. 15. Myocardial Pathophysiology Area, Fundación Centro Nacional de Investigaciones Cardiovasculares, Carlos III (CNIC), Madrid, Spain Department of Cardiology, Hospital Clínico San Carlos, Madrid, Spain. 16. Department of Signal Theory and Communications, Telematics and Computing, Universidad Rey Juan Carlos (URJC), Madrid, Spain.
Abstract
OBJECTIVE: A safety threshold for baseline rhythm R-wave amplitudes during follow-up of implantable cardioverter defibrillators (ICD) has not been established. We aimed to analyse the amplitude distribution and undersensing rate during spontaneous episodes of ventricular fibrillation (VF), and define a safety amplitude threshold for baseline R-waves. METHODS: Data were obtained from an observational multicentre registry conducted at 48 centres in Spain. Baseline R-wave amplitudes and VF events were prospectively registered by remote monitoring. Signal processing algorithms were used to compare amplitudes of baseline R-waves with VF R-waves. All undersensed R-waves after the blanking period (120 ms) were manually marked. RESULTS: We studied 2507 patients from August 2011 to September 2014, which yielded 229 VF episodes (cycle length 189.6±29.1 ms) from 83 patients that were suitable for R-wave comparisons (follow-up 2.7±2.6 years). The majority (77.6%) of VF R-waves (n=13953) showed lower amplitudes than the reference baseline R-wave. The decrease in VF amplitude was progressively attenuated among subgroups of baseline R-wave amplitude (≥17; ≥12 to <17; ≥7 to <12; ≥2.2 to <7 mV) from the highest to the lowest: median deviations -51.2% to +22.4%, respectively (p=0.027). There were no significant differences in undersensing rates of VF R-waves among subgroups. Both the normalised histogram distribution and the undersensing risk function obtained from the ≥2.2 to <7 mV subgroup enabled the prediction that baseline R-wave amplitudes ≤2.5 mV (interquartile range: 2.3-2.8 mV) may lead to ≥25% of undersensed VF R-waves. CONCLUSIONS: Baseline R-wave amplitudes ≤2.5 mV during follow-up of patients with ICDs may lead to high risk of delayed detection of VF. TRIAL REGISTRATION NUMBER: NCT01561144; results. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/
OBJECTIVE: A safety threshold for baseline rhythm R-wave amplitudes during follow-up of implantable cardioverter defibrillators (ICD) has not been established. We aimed to analyse the amplitude distribution and undersensing rate during spontaneous episodes of ventricular fibrillation (VF), and define a safety amplitude threshold for baseline R-waves. METHODS: Data were obtained from an observational multicentre registry conducted at 48 centres in Spain. Baseline R-wave amplitudes and VF events were prospectively registered by remote monitoring. Signal processing algorithms were used to compare amplitudes of baseline R-waves with VF R-waves. All undersensed R-waves after the blanking period (120 ms) were manually marked. RESULTS: We studied 2507 patients from August 2011 to September 2014, which yielded 229 VF episodes (cycle length 189.6±29.1 ms) from 83 patients that were suitable for R-wave comparisons (follow-up 2.7±2.6 years). The majority (77.6%) of VF R-waves (n=13953) showed lower amplitudes than the reference baseline R-wave. The decrease in VF amplitude was progressively attenuated among subgroups of baseline R-wave amplitude (≥17; ≥12 to <17; ≥7 to <12; ≥2.2 to <7 mV) from the highest to the lowest: median deviations -51.2% to +22.4%, respectively (p=0.027). There were no significant differences in undersensing rates of VF R-waves among subgroups. Both the normalised histogram distribution and the undersensing risk function obtained from the ≥2.2 to <7 mV subgroup enabled the prediction that baseline R-wave amplitudes ≤2.5 mV (interquartile range: 2.3-2.8 mV) may lead to ≥25% of undersensed VF R-waves. CONCLUSIONS: Baseline R-wave amplitudes ≤2.5 mV during follow-up of patients with ICDs may lead to high risk of delayed detection of VF. TRIAL REGISTRATION NUMBER: NCT01561144; results. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/
Authors: Bruce L Wilkoff; Laurence D Sterns; Michael S Katcher; Gaurav Upadhyay; Peter Seizer; Chaoyi Kang; Jennifer Rhude; Kevin J Davis; Avi Fischer Journal: Heart Rhythm O2 Date: 2021-11-18