Noise, artifact, and oversensing related inappropriate ICD shock evaluation: ALTITUDE noise study

Brian D. Powell, Samuel J Asirvatham, David L. Perschbacher, Paul W. Jones, Yong-Mei Cha, David A. Cesario, Michael Cao, F. Roosevelt Gilliam, Leslie A. Saxon

Research output: Contribution to journalArticle

38 Citations (Scopus)

Abstract

Background: Approximately 12-21% of implantable cardioverter defibrillator (ICD) patients receive inappropriate shocks. We sought to determine the incidence and causes of noise/artifact and oversensing (NAO) resulting in ICD shocks. Methods: A random sample of 2,000 patients who received ICD and cardiac resynchronization therapy defibrillator shocks and were followed by a remote monitoring system was included. Seven electrophysiologists analyzed stored electrograms from the 5,279 shock episodes. Episodes were adjudicated as appropriate or inappropriate shocks. Results: Of the 5,248 shock episodes with complete adjudication, 1,570 (30%) were judged to be inappropriate shocks. Of these 1,570, 134 (8.5%) were a result of NAO. The 134 NAO episodes were determined to be due to external noise in 76 (57%), lead connector-related in 37 (28%), muscle noise in 11 (8%), oversensing of atrium in seven (5%), T-wave oversensing in two (2%), and other noise in one (1%). The ICD shock itself resulted in a marked decrease in the level of noise in 60 of 134 (45%) NAO episodes, and the magnitude of this effect varied with the type of NAO (58% for external noise, 35% for muscle, 27% for lead/connector, and 0% for oversensing; P = 0.03). There was no significant difference in NAO likelihood based on type of lead (integrated bipolar 89/1,802 vs dedicated bipolar 9/140, P = 0.67). Conclusions: External noise and lead/connector noise were the primary causes, while T-wave oversensing was the least common cause of NAO resulting in ICD shock. Noise/artifact decreased immediately after a shock in nearly half of episodes. The specific ICD lead type did not impact the likelihood of NAO.

Original languageEnglish (US)
Pages (from-to)863-869
Number of pages7
JournalPACE - Pacing and Clinical Electrophysiology
Volume35
Issue number7
DOIs
StatePublished - Jul 2012

Fingerprint

Implantable Defibrillators
Artifacts
Noise
Shock
Muscles
Cardiac Resynchronization Therapy
Defibrillators

Keywords

  • arrhythmias cardiac
  • artifacts
  • cardiac resynchronization therapy
  • defibrillators
  • electromagnetic fields
  • implantable

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Noise, artifact, and oversensing related inappropriate ICD shock evaluation : ALTITUDE noise study. / Powell, Brian D.; Asirvatham, Samuel J; Perschbacher, David L.; Jones, Paul W.; Cha, Yong-Mei; Cesario, David A.; Cao, Michael; Gilliam, F. Roosevelt; Saxon, Leslie A.

In: PACE - Pacing and Clinical Electrophysiology, Vol. 35, No. 7, 07.2012, p. 863-869.

Research output: Contribution to journalArticle

Powell, Brian D. ; Asirvatham, Samuel J ; Perschbacher, David L. ; Jones, Paul W. ; Cha, Yong-Mei ; Cesario, David A. ; Cao, Michael ; Gilliam, F. Roosevelt ; Saxon, Leslie A. / Noise, artifact, and oversensing related inappropriate ICD shock evaluation : ALTITUDE noise study. In: PACE - Pacing and Clinical Electrophysiology. 2012 ; Vol. 35, No. 7. pp. 863-869.
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abstract = "Background: Approximately 12-21{\%} of implantable cardioverter defibrillator (ICD) patients receive inappropriate shocks. We sought to determine the incidence and causes of noise/artifact and oversensing (NAO) resulting in ICD shocks. Methods: A random sample of 2,000 patients who received ICD and cardiac resynchronization therapy defibrillator shocks and were followed by a remote monitoring system was included. Seven electrophysiologists analyzed stored electrograms from the 5,279 shock episodes. Episodes were adjudicated as appropriate or inappropriate shocks. Results: Of the 5,248 shock episodes with complete adjudication, 1,570 (30{\%}) were judged to be inappropriate shocks. Of these 1,570, 134 (8.5{\%}) were a result of NAO. The 134 NAO episodes were determined to be due to external noise in 76 (57{\%}), lead connector-related in 37 (28{\%}), muscle noise in 11 (8{\%}), oversensing of atrium in seven (5{\%}), T-wave oversensing in two (2{\%}), and other noise in one (1{\%}). The ICD shock itself resulted in a marked decrease in the level of noise in 60 of 134 (45{\%}) NAO episodes, and the magnitude of this effect varied with the type of NAO (58{\%} for external noise, 35{\%} for muscle, 27{\%} for lead/connector, and 0{\%} for oversensing; P = 0.03). There was no significant difference in NAO likelihood based on type of lead (integrated bipolar 89/1,802 vs dedicated bipolar 9/140, P = 0.67). Conclusions: External noise and lead/connector noise were the primary causes, while T-wave oversensing was the least common cause of NAO resulting in ICD shock. Noise/artifact decreased immediately after a shock in nearly half of episodes. The specific ICD lead type did not impact the likelihood of NAO.",
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T2 - ALTITUDE noise study

AU - Powell, Brian D.

AU - Asirvatham, Samuel J

AU - Perschbacher, David L.

AU - Jones, Paul W.

AU - Cha, Yong-Mei

AU - Cesario, David A.

AU - Cao, Michael

AU - Gilliam, F. Roosevelt

AU - Saxon, Leslie A.

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N2 - Background: Approximately 12-21% of implantable cardioverter defibrillator (ICD) patients receive inappropriate shocks. We sought to determine the incidence and causes of noise/artifact and oversensing (NAO) resulting in ICD shocks. Methods: A random sample of 2,000 patients who received ICD and cardiac resynchronization therapy defibrillator shocks and were followed by a remote monitoring system was included. Seven electrophysiologists analyzed stored electrograms from the 5,279 shock episodes. Episodes were adjudicated as appropriate or inappropriate shocks. Results: Of the 5,248 shock episodes with complete adjudication, 1,570 (30%) were judged to be inappropriate shocks. Of these 1,570, 134 (8.5%) were a result of NAO. The 134 NAO episodes were determined to be due to external noise in 76 (57%), lead connector-related in 37 (28%), muscle noise in 11 (8%), oversensing of atrium in seven (5%), T-wave oversensing in two (2%), and other noise in one (1%). The ICD shock itself resulted in a marked decrease in the level of noise in 60 of 134 (45%) NAO episodes, and the magnitude of this effect varied with the type of NAO (58% for external noise, 35% for muscle, 27% for lead/connector, and 0% for oversensing; P = 0.03). There was no significant difference in NAO likelihood based on type of lead (integrated bipolar 89/1,802 vs dedicated bipolar 9/140, P = 0.67). Conclusions: External noise and lead/connector noise were the primary causes, while T-wave oversensing was the least common cause of NAO resulting in ICD shock. Noise/artifact decreased immediately after a shock in nearly half of episodes. The specific ICD lead type did not impact the likelihood of NAO.

AB - Background: Approximately 12-21% of implantable cardioverter defibrillator (ICD) patients receive inappropriate shocks. We sought to determine the incidence and causes of noise/artifact and oversensing (NAO) resulting in ICD shocks. Methods: A random sample of 2,000 patients who received ICD and cardiac resynchronization therapy defibrillator shocks and were followed by a remote monitoring system was included. Seven electrophysiologists analyzed stored electrograms from the 5,279 shock episodes. Episodes were adjudicated as appropriate or inappropriate shocks. Results: Of the 5,248 shock episodes with complete adjudication, 1,570 (30%) were judged to be inappropriate shocks. Of these 1,570, 134 (8.5%) were a result of NAO. The 134 NAO episodes were determined to be due to external noise in 76 (57%), lead connector-related in 37 (28%), muscle noise in 11 (8%), oversensing of atrium in seven (5%), T-wave oversensing in two (2%), and other noise in one (1%). The ICD shock itself resulted in a marked decrease in the level of noise in 60 of 134 (45%) NAO episodes, and the magnitude of this effect varied with the type of NAO (58% for external noise, 35% for muscle, 27% for lead/connector, and 0% for oversensing; P = 0.03). There was no significant difference in NAO likelihood based on type of lead (integrated bipolar 89/1,802 vs dedicated bipolar 9/140, P = 0.67). Conclusions: External noise and lead/connector noise were the primary causes, while T-wave oversensing was the least common cause of NAO resulting in ICD shock. Noise/artifact decreased immediately after a shock in nearly half of episodes. The specific ICD lead type did not impact the likelihood of NAO.

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KW - artifacts

KW - cardiac resynchronization therapy

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KW - electromagnetic fields

KW - implantable

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