A Comparative Study Of The Parameters Measured By Implantable Cardioverter Defibrillator Of Different Brands And Pacing System Analyzer During ICD Implanting Procedure

Object:Sensing ability of Implantable Cardioverter Defibrillator(ICD)is prerequisite for its defibrillation function.The R-wave amplitude detected by pacing system analyzer(PSA)during ICD implanting procedure is the basis of the sensing ability of ICD.We aimed to compare the parameters measured by ICDs of different brands and PSA,and summarize the characteristics of the ICDs of different brands,and help doctors have deeper understanding of ICDs.Methods:Patients who received cardiac implantable electronic devices(CIED)to treat arrhythmias in department of cardiology in Drum Tower hospital during September 2015 to December 2015 were enrolled.The R-wave amplitude and impedance were tested by ICD prototypes of different brands and PSA respectively.The intracardiac electrocardiograms(ECG)recorded by ICDs were printed by program-controlled analyzer.The R-wave amplitude and the T-wave amplitude shown on the electrocardiogram were measured manually and the difference between the two values was calculated.The value was defined as the R wave safety margin.The R-wave amplitude and impedance measured by ICDs and pacing system analyzer were compared with each other.R-wave safety margin and morphology of intracardiac ECG sensed by different ICDs were compared with each other.Results:A total of 30 patients were enrolled in this study at last.The R-wave amplitude and impedance measured by 5318 pacing system analyzer from 30 patients,were recorded,the R-wave amplitude,impedance and intracardiac electrocardiogram measured by ICDs of Medtronic,Biotronik and Boston Scientific were recorded from 30 patients,the R-wave amplitude,impedance and intracardiac electrocardiogram measured by St.Jude ICD were recorded form 22 patients.1.The QRS waveform and T-waveform of the intracardiac electrocardiogram,which were sensed by different ICDs from one of the patients,were different.2.The average R-wave amplitude measured by 5318 PSA during the implanting procedure was 14.1 ±4.3mv,which was significantly higher than those sensed by ICDs of different brands(P?0.001).The R-wave amplitude sensed by Medtronic ICD is the lowest(7.9± 3.1mv).3.There was a significant difference between the R-wave amplitude sensed by ICDs and the R-wave amplitude hand-measured from the intracardiac electrocardiogram,except Biotronik ICD and Boston Scientific ICD.The maximum R-wave safety margin was 12.0 ± 3.1mv hand-measured from the intracardiac ECG sensed by Boston Scientific ICD,and there was no significant difference between the R-wave safety margin of Boston Scientific ICD and St.Jude ICD(12.0 ± 3.1 m vs VS 10.9± 2.6,P = 0.667).4.There was statistically significant difference between the lead impedances measured by 5318 PSA and ICDs of different grands and the impedance measured by 5318 PSA was 823 ± 261?,higher than those measured by ICDs.Conclusion:1.Morphologies of intracardiac ECG sensed by ICDs from different brands are not same,R-wave amplitude and T-wave amplitude are also different,it may be because of the different perception algorithm and band-pass filter used by different ICDs.2.The R-wave amplitude sensed by ICDs of different brands were lower than that sensed by 5318 PSA,and there was also a significant difference between the R-wave amplitude sensed by ICDs of different brands,the result suggests that there are different minimum value of R-wave amplitudes sensed by 5318 PSA for ICDs of different grands.There were statistically significant difference between R-wave safety margins sensed by ICDs of different brands,it may be related with the incidence of T-wave oversensing,the clinical significance of it needs further research.3.There were significant difference between the impedances measured by 5318 PSA and ICDs of different grands,this difference has no influence on doctors to determine the integrity of lead after implanting procedure.