Use of an intracardiac electrogram eliminates the need for a surface ECG during implantable cardioverter-defibrillator follow-up

Michael, Kevin A., Peterson, Brett J., Yue, Arthur M., Wilson, Ryan D., Wang, Li, Ousdigian, Kevin, Wilkoff, Bruce, Sterns, Laurence and Morgan, John M. (2007) Use of an intracardiac electrogram eliminates the need for a surface ECG during implantable cardioverter-defibrillator follow-up. Pacing and Clinical Electrophysiology, 30 (12), 1432-1437. (doi:10.1111/j.1540-8159.2007.00888.x).

Abstract

BACKGROUND: A surface electrocardiogram (SECG) for pacing threshold measurements during routine implantable cardioverter-defibrillator (ICD) follow-up can be cumbersome. This study evaluated the use of an intrathoracic far-field electrogram (EGM) derived between the Can and superior vena cava (SVC) electrode -- the Leadless electrocardiogram (LLECG), in dual chamber ICDs in performing pacing threshold tests. METHODS: The LLECG was evaluated prospectively during atrial and ventricular pacing threshold testing as a substudy of the Comparison of Empiric to Physician-Tailored Programming of Implantable Cardioverter-Defibrillators trial (EMPIRIC) in which dual chamber ICDs were implanted in 888 patients. Threshold tests were conducted at 1 volt by decrementing the pulse width. Follow-up at three months compared pacing thresholds measured using LLECG with those using Lead I of the surface ECG (SECG). The timesaving afforded by LLECG was assessed by a questionnaire. RESULTS: The median threshold difference between LLECG and SECG measurements for both atrial (0.00 ms, P = 0.90) and ventricular (0.00 ms, P = 0.34) threshold tests were not significant. Ninety percent of atrial and ventricular threshold differences were bounded by +/- 0.10 ms and -0.10 to +0.04 ms, respectively. We found that 99% of atrial and ventricular thresholds tests at six and 12 months attempted using LLECG were successfully completed. The questionnaire indicated that 65% of healthcare professionals found LLECG to afford at least some timesaving during device follow-ups. CONCLUSION: Routine follow-up can be performed reliably and expeditiously in dual chamber Medtronic (Minneapolis, MN, USA) ICDs using LLECG alone, resulting in overall timesaving.

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