Appropriate and inappropriate electrical therapies delivered by an implantable cardioverter-defibrillator: Effect on intracardiac electrogram

Peter Stempniewicz, Alan Cheng, Allison Connolly, Xin Yuan Wang, Hugh Calkins, Gordon F. Tomaselli, Ronald D. Berger, Larisa G. Tereshchenko

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

Intracardiac EGM After ICD Therapies. Introduction: Local injury current (LIC) seen after induced ventricular fibrillation rescue implantable cardioverter-defibrillator (ICD) shock predicts heart failure progression. We sought to determine the frequency of LIC after spontaneous events in patients receiving ICD therapies. Methods and Results: Near-field (NF) right ventricular (RV) EGM during 10 seconds after delivered ICD therapy was compared with baseline EGM in 420 events that occurred in 134 patients (mean age 60.8 ± 14.8, 106 [79%] male). The magnitude of elevated or depressed potential immediately after the major fast EGM deflection was defined as LIC, and its ratio to the peak-to-peak EGM amplitude was defined as relative LIC. LIC of at least 1 mV or relative LIC of at least 15% was considered significant. LIC was observed in 121 events (28.8%) and was detected more frequently after appropriate (43 [60.6%] events) and inappropriate (56 [64.4%] events) ICD shocks, as compared with appropriate (8 [9.2%] events) and inappropriate (3 [4.7%] events) antitachycardia pacing (ATP) or nonsustained ventricular tachycardia (11 [9.9%] events) [ANOVA P < 0.0001]. Type of ICD therapy (ICD shock vs ATP) was the most significant predictor of LIC (ATP β coefficient -0.81; 95%CI-1.19 to 0.44); P < 0.0001), along with cycle length of tachycardia (β coefficient -0.0117; 95%CI -0.0167 to -0.0068, P < 0.00001) and shock energy (β coefficient 0.024; 95%CI 0.003-0.045, P = 0.025). Conclusion: Appropriate and inappropriate ICD shocks are frequently characterized by the development of LIC in patients with structural heart disease. Type of electrical ICD therapy, shock energy and cycle length of ventricular arrhythmia are important determinants of LIC. (J Cardiovasc Electrophysiol, Vol. 22, pp. 554-560 May 2011)

Original languageEnglish (US)
Pages (from-to)554-560
Number of pages7
JournalJournal of Cardiovascular Electrophysiology
Volume22
Issue number5
DOIs
StatePublished - May 1 2011
Externally publishedYes

Fingerprint

Cardiac Electrophysiologic Techniques
Implantable Defibrillators
Wounds and Injuries
Shock
Therapeutics
Convulsive Therapy
Ventricular Fibrillation
Ventricular Tachycardia
Tachycardia
Cardiac Arrhythmias
Heart Diseases
Analysis of Variance
Heart Failure

Keywords

  • antitachycardia pacing
  • defibrillation
  • ventricular arrhythmia

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Appropriate and inappropriate electrical therapies delivered by an implantable cardioverter-defibrillator : Effect on intracardiac electrogram. / Stempniewicz, Peter; Cheng, Alan; Connolly, Allison; Wang, Xin Yuan; Calkins, Hugh; Tomaselli, Gordon F.; Berger, Ronald D.; Tereshchenko, Larisa G.

In: Journal of Cardiovascular Electrophysiology, Vol. 22, No. 5, 01.05.2011, p. 554-560.

Research output: Contribution to journalArticle

Stempniewicz, Peter ; Cheng, Alan ; Connolly, Allison ; Wang, Xin Yuan ; Calkins, Hugh ; Tomaselli, Gordon F. ; Berger, Ronald D. ; Tereshchenko, Larisa G. / Appropriate and inappropriate electrical therapies delivered by an implantable cardioverter-defibrillator : Effect on intracardiac electrogram. In: Journal of Cardiovascular Electrophysiology. 2011 ; Vol. 22, No. 5. pp. 554-560.
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abstract = "Intracardiac EGM After ICD Therapies. Introduction: Local injury current (LIC) seen after induced ventricular fibrillation rescue implantable cardioverter-defibrillator (ICD) shock predicts heart failure progression. We sought to determine the frequency of LIC after spontaneous events in patients receiving ICD therapies. Methods and Results: Near-field (NF) right ventricular (RV) EGM during 10 seconds after delivered ICD therapy was compared with baseline EGM in 420 events that occurred in 134 patients (mean age 60.8 ± 14.8, 106 [79{\%}] male). The magnitude of elevated or depressed potential immediately after the major fast EGM deflection was defined as LIC, and its ratio to the peak-to-peak EGM amplitude was defined as relative LIC. LIC of at least 1 mV or relative LIC of at least 15{\%} was considered significant. LIC was observed in 121 events (28.8{\%}) and was detected more frequently after appropriate (43 [60.6{\%}] events) and inappropriate (56 [64.4{\%}] events) ICD shocks, as compared with appropriate (8 [9.2{\%}] events) and inappropriate (3 [4.7{\%}] events) antitachycardia pacing (ATP) or nonsustained ventricular tachycardia (11 [9.9{\%}] events) [ANOVA P < 0.0001]. Type of ICD therapy (ICD shock vs ATP) was the most significant predictor of LIC (ATP β coefficient -0.81; 95{\%}CI-1.19 to 0.44); P < 0.0001), along with cycle length of tachycardia (β coefficient -0.0117; 95{\%}CI -0.0167 to -0.0068, P < 0.00001) and shock energy (β coefficient 0.024; 95{\%}CI 0.003-0.045, P = 0.025). Conclusion: Appropriate and inappropriate ICD shocks are frequently characterized by the development of LIC in patients with structural heart disease. Type of electrical ICD therapy, shock energy and cycle length of ventricular arrhythmia are important determinants of LIC. (J Cardiovasc Electrophysiol, Vol. 22, pp. 554-560 May 2011)",
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AU - Cheng, Alan

AU - Connolly, Allison

AU - Wang, Xin Yuan

AU - Calkins, Hugh

AU - Tomaselli, Gordon F.

AU - Berger, Ronald D.

AU - Tereshchenko, Larisa G.

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N2 - Intracardiac EGM After ICD Therapies. Introduction: Local injury current (LIC) seen after induced ventricular fibrillation rescue implantable cardioverter-defibrillator (ICD) shock predicts heart failure progression. We sought to determine the frequency of LIC after spontaneous events in patients receiving ICD therapies. Methods and Results: Near-field (NF) right ventricular (RV) EGM during 10 seconds after delivered ICD therapy was compared with baseline EGM in 420 events that occurred in 134 patients (mean age 60.8 ± 14.8, 106 [79%] male). The magnitude of elevated or depressed potential immediately after the major fast EGM deflection was defined as LIC, and its ratio to the peak-to-peak EGM amplitude was defined as relative LIC. LIC of at least 1 mV or relative LIC of at least 15% was considered significant. LIC was observed in 121 events (28.8%) and was detected more frequently after appropriate (43 [60.6%] events) and inappropriate (56 [64.4%] events) ICD shocks, as compared with appropriate (8 [9.2%] events) and inappropriate (3 [4.7%] events) antitachycardia pacing (ATP) or nonsustained ventricular tachycardia (11 [9.9%] events) [ANOVA P < 0.0001]. Type of ICD therapy (ICD shock vs ATP) was the most significant predictor of LIC (ATP β coefficient -0.81; 95%CI-1.19 to 0.44); P < 0.0001), along with cycle length of tachycardia (β coefficient -0.0117; 95%CI -0.0167 to -0.0068, P < 0.00001) and shock energy (β coefficient 0.024; 95%CI 0.003-0.045, P = 0.025). Conclusion: Appropriate and inappropriate ICD shocks are frequently characterized by the development of LIC in patients with structural heart disease. Type of electrical ICD therapy, shock energy and cycle length of ventricular arrhythmia are important determinants of LIC. (J Cardiovasc Electrophysiol, Vol. 22, pp. 554-560 May 2011)

AB - Intracardiac EGM After ICD Therapies. Introduction: Local injury current (LIC) seen after induced ventricular fibrillation rescue implantable cardioverter-defibrillator (ICD) shock predicts heart failure progression. We sought to determine the frequency of LIC after spontaneous events in patients receiving ICD therapies. Methods and Results: Near-field (NF) right ventricular (RV) EGM during 10 seconds after delivered ICD therapy was compared with baseline EGM in 420 events that occurred in 134 patients (mean age 60.8 ± 14.8, 106 [79%] male). The magnitude of elevated or depressed potential immediately after the major fast EGM deflection was defined as LIC, and its ratio to the peak-to-peak EGM amplitude was defined as relative LIC. LIC of at least 1 mV or relative LIC of at least 15% was considered significant. LIC was observed in 121 events (28.8%) and was detected more frequently after appropriate (43 [60.6%] events) and inappropriate (56 [64.4%] events) ICD shocks, as compared with appropriate (8 [9.2%] events) and inappropriate (3 [4.7%] events) antitachycardia pacing (ATP) or nonsustained ventricular tachycardia (11 [9.9%] events) [ANOVA P < 0.0001]. Type of ICD therapy (ICD shock vs ATP) was the most significant predictor of LIC (ATP β coefficient -0.81; 95%CI-1.19 to 0.44); P < 0.0001), along with cycle length of tachycardia (β coefficient -0.0117; 95%CI -0.0167 to -0.0068, P < 0.00001) and shock energy (β coefficient 0.024; 95%CI 0.003-0.045, P = 0.025). Conclusion: Appropriate and inappropriate ICD shocks are frequently characterized by the development of LIC in patients with structural heart disease. Type of electrical ICD therapy, shock energy and cycle length of ventricular arrhythmia are important determinants of LIC. (J Cardiovasc Electrophysiol, Vol. 22, pp. 554-560 May 2011)

KW - antitachycardia pacing

KW - defibrillation

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