Quantification of Electromechanical Coupling to Prevent Inappropriate Implantable Cardioverter-Defibrillator Shocks
Daniel Keene, Matthew J. Shun-Shin, Ahran D. Arnold, James P. Howard, David Lefroy, D. Wyn Davies, Phang Boon Lim, Fu Siong Ng, Michael Koa-Wing, Norman A. Qureshi, Nick W.F. Linton, Jaymin S. Shah, Nicholas S. Peters, Prapa Kanagaratnam, Darrel P. Francis and Zachary I. Whinnett
The Electro-Mechanical Coupling Approach in Situations Where Inappropriate Therapies May Otherwise Result
Sinus Rhythm: Gating the laser Doppler signal by the R-R interval from the right ventricular (RV) lead shows a satisfactory consensus perfusion value. A similar situation would occur in other well tolerated rhythm disturbances. RV lead fracture: Gating the laser Doppler signal by the R-R interval from the fractured RV lead shows an unsatisfactory perfusion value. When gating is performed by an alternate electrical signal (atrial lead in this example) a satisfactory consensus perfusion value is seen. EGM oversensing: Gating the laser Doppler signal by the R-R interval from the RV lead shows an unsatisfactory perfusion value. Appropriate gating by the algorithm (which simultaneously tests multiple hypotheses as to which are the true R waves) shows a satisfactory consensus perfusion value. True VF: Gating the laser Doppler signal by R-R intervals detected by the ICD lead, alternate electrical signal and by the multiple hypothesis method each time reveals no satisfactory perfusion. ECG = electrocardiogram; EGM = electrogram; ICD = implantable cardioverter-defibrillator; VF = ventricular fibrillation.