Analysis of arrhythmic events is useful to detect lead failure earlier in patients followed by remote monitoring

Nobuhiro Nishii, Akihito Miyoshi, Motoki Kubo, Masakazu Miyamoto, Yoshimasa Morimoto, Satoshi Kawada, Koji Nakagawa, Atsuyuki Watanabe, Kazufumi Nakamura, Hiroshi Morita, Hiroshi Ito

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Background: Remote monitoring (RM) has been advocated as the new standard of care for patients with cardiovascular implantable electronic devices (CIEDs). RM has allowed the early detection of adverse clinical events, such as arrhythmia, lead failure, and battery depletion. However, lead failure was often identified only by arrhythmic events, but not impedance abnormalities. Objective: To compare the usefulness of arrhythmic events with conventional impedance abnormalities for identifying lead failure in CIED patients followed by RM. Methods: CIED patients in 12 hospitals have been followed by the RM center in Okayama University Hospital. All transmitted data have been analyzed and summarized. Results: From April 2009 to March 2016, 1,873 patients have been followed by the RM center. During the mean follow-up period of 775 days, 42 lead failure events (atrial lead 22, right ventricular pacemaker lead 5, implantable cardioverter defibrillator [ICD] lead 15) were detected. The proportion of lead failures detected only by arrhythmic events, which were not detected by conventional impedance abnormalities, was significantly higher than that detected by impedance abnormalities (arrhythmic event 76.2%, 95% CI: 60.5-87.9%; impedance abnormalities 23.8%, 95% CI: 12.1-39.5%). Twenty-seven events (64.7%) were detected without any alert. Of 15 patients with ICD lead failure, none has experienced inappropriate therapy. Conclusions: RM can detect lead failure earlier, before clinical adverse events. However, CIEDs often diagnose lead failure as just arrhythmic events without any warning. Thus, to detect lead failure earlier, careful human analysis of arrhythmic events is useful.

Original languageEnglish
JournalJournal of Cardiovascular Electrophysiology
DOIs
Publication statusAccepted/In press - Jan 1 2017

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Electric Impedance
Equipment and Supplies
Implantable Defibrillators
Lead
Standard of Care
Cardiac Arrhythmias
Therapeutics

Keywords

  • Impedance abnormality
  • Inappropriate therapy
  • Intracardiac electrogram
  • Lead failure
  • Remote monitoring

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

@article{de9bc3d978b9410caedba85721080b16,
title = "Analysis of arrhythmic events is useful to detect lead failure earlier in patients followed by remote monitoring",
abstract = "Background: Remote monitoring (RM) has been advocated as the new standard of care for patients with cardiovascular implantable electronic devices (CIEDs). RM has allowed the early detection of adverse clinical events, such as arrhythmia, lead failure, and battery depletion. However, lead failure was often identified only by arrhythmic events, but not impedance abnormalities. Objective: To compare the usefulness of arrhythmic events with conventional impedance abnormalities for identifying lead failure in CIED patients followed by RM. Methods: CIED patients in 12 hospitals have been followed by the RM center in Okayama University Hospital. All transmitted data have been analyzed and summarized. Results: From April 2009 to March 2016, 1,873 patients have been followed by the RM center. During the mean follow-up period of 775 days, 42 lead failure events (atrial lead 22, right ventricular pacemaker lead 5, implantable cardioverter defibrillator [ICD] lead 15) were detected. The proportion of lead failures detected only by arrhythmic events, which were not detected by conventional impedance abnormalities, was significantly higher than that detected by impedance abnormalities (arrhythmic event 76.2{\%}, 95{\%} CI: 60.5-87.9{\%}; impedance abnormalities 23.8{\%}, 95{\%} CI: 12.1-39.5{\%}). Twenty-seven events (64.7{\%}) were detected without any alert. Of 15 patients with ICD lead failure, none has experienced inappropriate therapy. Conclusions: RM can detect lead failure earlier, before clinical adverse events. However, CIEDs often diagnose lead failure as just arrhythmic events without any warning. Thus, to detect lead failure earlier, careful human analysis of arrhythmic events is useful.",
keywords = "Impedance abnormality, Inappropriate therapy, Intracardiac electrogram, Lead failure, Remote monitoring",
author = "Nobuhiro Nishii and Akihito Miyoshi and Motoki Kubo and Masakazu Miyamoto and Yoshimasa Morimoto and Satoshi Kawada and Koji Nakagawa and Atsuyuki Watanabe and Kazufumi Nakamura and Hiroshi Morita and Hiroshi Ito",
year = "2017",
month = "1",
day = "1",
doi = "10.1111/jce.13399",
language = "English",
journal = "Journal of Cardiovascular Electrophysiology",
issn = "1045-3873",
publisher = "Wiley-Blackwell",

}

TY - JOUR

T1 - Analysis of arrhythmic events is useful to detect lead failure earlier in patients followed by remote monitoring

AU - Nishii, Nobuhiro

AU - Miyoshi, Akihito

AU - Kubo, Motoki

AU - Miyamoto, Masakazu

AU - Morimoto, Yoshimasa

AU - Kawada, Satoshi

AU - Nakagawa, Koji

AU - Watanabe, Atsuyuki

AU - Nakamura, Kazufumi

AU - Morita, Hiroshi

AU - Ito, Hiroshi

PY - 2017/1/1

Y1 - 2017/1/1

N2 - Background: Remote monitoring (RM) has been advocated as the new standard of care for patients with cardiovascular implantable electronic devices (CIEDs). RM has allowed the early detection of adverse clinical events, such as arrhythmia, lead failure, and battery depletion. However, lead failure was often identified only by arrhythmic events, but not impedance abnormalities. Objective: To compare the usefulness of arrhythmic events with conventional impedance abnormalities for identifying lead failure in CIED patients followed by RM. Methods: CIED patients in 12 hospitals have been followed by the RM center in Okayama University Hospital. All transmitted data have been analyzed and summarized. Results: From April 2009 to March 2016, 1,873 patients have been followed by the RM center. During the mean follow-up period of 775 days, 42 lead failure events (atrial lead 22, right ventricular pacemaker lead 5, implantable cardioverter defibrillator [ICD] lead 15) were detected. The proportion of lead failures detected only by arrhythmic events, which were not detected by conventional impedance abnormalities, was significantly higher than that detected by impedance abnormalities (arrhythmic event 76.2%, 95% CI: 60.5-87.9%; impedance abnormalities 23.8%, 95% CI: 12.1-39.5%). Twenty-seven events (64.7%) were detected without any alert. Of 15 patients with ICD lead failure, none has experienced inappropriate therapy. Conclusions: RM can detect lead failure earlier, before clinical adverse events. However, CIEDs often diagnose lead failure as just arrhythmic events without any warning. Thus, to detect lead failure earlier, careful human analysis of arrhythmic events is useful.

AB - Background: Remote monitoring (RM) has been advocated as the new standard of care for patients with cardiovascular implantable electronic devices (CIEDs). RM has allowed the early detection of adverse clinical events, such as arrhythmia, lead failure, and battery depletion. However, lead failure was often identified only by arrhythmic events, but not impedance abnormalities. Objective: To compare the usefulness of arrhythmic events with conventional impedance abnormalities for identifying lead failure in CIED patients followed by RM. Methods: CIED patients in 12 hospitals have been followed by the RM center in Okayama University Hospital. All transmitted data have been analyzed and summarized. Results: From April 2009 to March 2016, 1,873 patients have been followed by the RM center. During the mean follow-up period of 775 days, 42 lead failure events (atrial lead 22, right ventricular pacemaker lead 5, implantable cardioverter defibrillator [ICD] lead 15) were detected. The proportion of lead failures detected only by arrhythmic events, which were not detected by conventional impedance abnormalities, was significantly higher than that detected by impedance abnormalities (arrhythmic event 76.2%, 95% CI: 60.5-87.9%; impedance abnormalities 23.8%, 95% CI: 12.1-39.5%). Twenty-seven events (64.7%) were detected without any alert. Of 15 patients with ICD lead failure, none has experienced inappropriate therapy. Conclusions: RM can detect lead failure earlier, before clinical adverse events. However, CIEDs often diagnose lead failure as just arrhythmic events without any warning. Thus, to detect lead failure earlier, careful human analysis of arrhythmic events is useful.

KW - Impedance abnormality

KW - Inappropriate therapy

KW - Intracardiac electrogram

KW - Lead failure

KW - Remote monitoring

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U2 - 10.1111/jce.13399

DO - 10.1111/jce.13399

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C2 - 29194831

AN - SCOPUS:85038251245

JO - Journal of Cardiovascular Electrophysiology

JF - Journal of Cardiovascular Electrophysiology

SN - 1045-3873

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