Document Detail


Which Patients are Not Suitable for a Subcutaneous ICD: Incidence and Predictors of Failed QRS-T-Wave Morphology Screening.
MedLine Citation:
PMID:  24320684     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
BACKGROUND: The subcutaneous cardioverter-defibrillator (S-ICD) relies on a pre-implantation QRS-T morphology screening (TMS) of the ECG to assure that it reliably detects the QRS-complexes and T-waves. The prevalence and clinical characteristics of the patients who fail this TMS is unknown.
METHODS AND RESULTS: QRS-T morphology screening was done in 230 consecutive ICD outpatients (75% male, age 57±15 years) without an indication for cardiac pacing, using an ECG simulating the three sensing vectors of the S-ICD (TMS-ECG). Patients were defined suitable when at least one sensing vector was considered appropriate in both supine and standing position. In total, 7.4% of patients, who were all male, were considered not suitable for a S-ICD according to the TMS-ECG. Independent predictors for TMS failure were hypertrophic cardiomyopathy (HCM; OR 12.6), a heavy weight (OR 1.5), a prolonged QRS duration (OR 1.5) and a R:T ratio <3 in the lead with the largest T-wave on a standard 12-lead surface ECG (OR 14.6).
CONCLUSION: In patients without an indication for pacing, 7.4% would have been not suitable for a S-ICD according to the TMS. HCM, a heavy weight, a prolonged QRS duration and a R:T ratio <3 in the ECG lead with the largest T-wave were independently associated with TMS failure. These data might alert physicians that selection of patients for a S-ICD should be considered with special caution in certain patient groups, because they may not satisfy ECG criteria for adequate sensing. This article is protected by copyright. All rights reserved.
Authors:
Louise R A Olde Nordkamp; Joppe L F Warnaars; Kirsten M Kooiman; Joris R DE Groot; Boudewijn R A M Rosenmöller; Arthur A M Wilde; Reinoud E Knops
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2013-12-9
Journal Detail:
Title:  Journal of cardiovascular electrophysiology     Volume:  -     ISSN:  1540-8167     ISO Abbreviation:  J. Cardiovasc. Electrophysiol.     Publication Date:  2013 Dec 
Date Detail:
Created Date:  2013-12-10     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9010756     Medline TA:  J Cardiovasc Electrophysiol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
This article is protected by copyright. All rights reserved.
Affiliation:
Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands.
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