Document Detail

Morphology-enhanced atrial event classification improves sensing in pacemakers.
MedLine Citation:
PMID:  18070298     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: In atrial-based pacing, appropriate therapy and reliable diagnostics depend on detection and discrimination of atrial signals. Accurate classification of atrial events is mainly confounded by oversensing of ventricular far-field R-wave signals (FFRW), but attempts to reject FFRWs by manipulating atrial sensitivity and/or postventricular atrial blanking period (PVAB) may result in undersensing (especially of atrial fibrillation, AF) or in 2:1 atrial flutter detection. The objective of this study is therefore to evaluate if such methods can be improved by morphology-enhanced atrial event classification (MORPH). METHODS: Twenty-four-hour ambulatory atrial electrograms were recorded from continuous telemetry of digital pacemakers. Half of the recording was used for collecting two individual morphology parameters that discriminated P-waves from FFRWs in every patient (learning phase). The other half was used to test the MORPH algorithm against traditional methods (classification phase). RESULTS: In 44/48 patients, data were suitable for analysis. Average P and FFRW amplitudes were 1.96 mV versus 0.61 mV (P < 0.001). The interval between ventricular events and FFRW oversensing (VA interval) averaged at 14 ms during sensing and at 118 ms during pacing in the ventricle. Compared to nominal ("Factory") settings, the MORPH algorithm improved the sensitivity for P-wave recognition from 97.2% to 99.2%, the specificity from 91.9% to 99.96%, and the accuracy from 95.3% to 99.4% (P < 0.01 for all). CONCLUSIONS: By improving atrial signal discrimination, morphology analysis of atrial electrograms allows for high atrial sensitivity settings, and potentially improves the reliability of atrial arrhythmia diagnostics in heart rhythm devices.
Thorsten Lewalter; Ype Tuininga; Gerd Fröhlig; Susann Remerie; Frank Eberhardt; Jörg Schmidt; Chris van Groeningen; Peter Wohlgemuth
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Publication Detail:
Type:  Journal Article; Multicenter Study; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Pacing and clinical electrophysiology : PACE     Volume:  30     ISSN:  0147-8389     ISO Abbreviation:  Pacing Clin Electrophysiol     Publication Date:  2007 Dec 
Date Detail:
Created Date:  2007-12-11     Completed Date:  2008-03-07     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7803944     Medline TA:  Pacing Clin Electrophysiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1455-63     Citation Subset:  IM    
Department of Cardiology, University of Bonn, Bonn, Germany.
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MeSH Terms
Atrial Fibrillation / physiopathology,  therapy
Bundle-Branch Block / physiopathology,  therapy
Cardiac Pacing, Artificial / methods*,  standards*
Chi-Square Distribution
Electrocardiography, Ambulatory
Heart Atria / physiopathology*
Pacemaker, Artificial / standards*
Prospective Studies
Sensitivity and Specificity
Sensory Thresholds
Sick Sinus Syndrome / physiopathology,  therapy
Signal Processing, Computer-Assisted
Statistics, Nonparametric

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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