[Dysfunctions of transvenous cardioverter/defibrillator electrode systems: clinical significance of system integrated diagnosis and measurement function--possibilities of partially automated system control].
The aim of this study is the analysis of electrical failures in transvenous cardioverter/defibrillator (ICD) lead systems with regard to the importance of device implemented diagnostic and measurement functions and the potential role of an automated device-control in the detection of lead failures.


METHODS
All consecutive ICD patients at our institution were enrolled in this retrospective investigation. The routine follow-up controls consisted in a complete evaluation of all diagnostic and measurement ICD features and additional controls in case of spontaneous arrhythmia episodes.


RESULTS
Two hundred thirty patients, 193 male and 37 female, were enrolled in this study (mean age: 61.5 +/- 10.2 years; mean LVEF 32 +/- 9%). During a mean follow-up period of 29.5 +/- 18.4 (6-76) months, lead failure occurred in 19 patients (8%), 16 patients were implanted with an ICD, capable of diagnostic and measurement functions. All nonadequate device discharges could be classified as sensing-failure by stored electrograms. Device implemented measurement features revealed clinical important information in 13/16 patients (81%). In 14/16 patients, the lead defect could not be detected during routine follow-up. At the time of documented lead failure the safety of the implanted devices was already lost in 6/16 patients (38%).


CONCLUSIONS
Device implemented diagnostic and measurement options are of great importance in the early detection of ICD lead failures. The implementation of automated measurements of lead related parameters in connection with a patient alert function may contribute to a further increase in the safety of ICD therapy.
Schulte
B
B
Abteilung Kardiologie, Kerckhoff-Klinik Max-Planck-Institut für physiologische und klinische Forschung, Bad Nauheim.
Schwarz
T
T
Sperzel
J
J
Pitschner
H F
HF
Klövekorn
W P
WP
Neuzner
J
J
D000328:Adult; D000368:Aged; D017147:Defibrillators, Implantable; D004562:Electrocardiography / Q000295:instrumentation; D004566:Electrodes; D019544:Equipment Failure Analysis / Q000295:instrumentation*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012815:Signal Processing, Computer-Assisted / Q000295:instrumentation*; D013597:Systems Analysis
Dysfunktionen transvenöser Kardioverter/Defibrillator-Elektrodensysteme: klinische Bedeutung systemintegrierter Diagnose- und Messfunktionen--Möglichkeiten einer teilautomatisierten Systemkontrolle.