Sensitivity and specificity of the subcutaneous implantable cardioverter defibrillator pre-implant screening tool
| Autor: | Mehmood Zeb, John M. Morgan, Venugopal Allavatam, Nick Curzen, David I. Wilson, Paul R. Roberts, Arthur M. Yue |
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| Rok vydání: | 2015 |
| Předmět: |
Adult
Heart Defects Congenital Male medicine.medical_specialty medicine.medical_treatment Electric Countershock Sensitivity and Specificity Sudden cardiac death Prosthesis Implantation Electrocardiography symbols.namesake Postoperative Complications McNemar's test Predictive Value of Tests Internal medicine Preoperative Care medicine Humans Mass Screening Screening tool Fisher's exact test Tetralogy of Fallot business.industry Patient Selection Body Surface Potential Mapping medicine.disease Implantable cardioverter-defibrillator United Kingdom Defibrillators Implantable Death Sudden Cardiac Great arteries Cardiology symbols Female Implant Cardiology and Cardiovascular Medicine business Algorithms |
| Zdroj: | International Journal of Cardiology. 195:205-209 |
| ISSN: | 0167-5273 |
| DOI: | 10.1016/j.ijcard.2015.05.082 |
| Popis: | BackgroundThe sensitivity and specificity of the subcutaneous implantable cardioverter defibrillator (S-ICD) pre-implant screening tool required clinical evaluation.MethodsBipolar vectors were derived from electrodes positioned at locations similar to those employed for S-ICD sensing and pre-implant screening electrodes, and recordings collected through 80-electrode PRIME®-ECGs, in six different postures, from 40 subjects (10 healthy controls, and 30 patients with complex congenital heart disease (CCHD); 10 with Tetralogy of Fallot (TOF), 10 with single ventricle physiology (SVP), and 10 with transposition of great arteries (TGA)). The resulting vectors were analysed using the S-ICD pre-implant screening tool (Boston Scientific) and processed through the sensing algorithm of S-ICD (Boston Scientific). The data were then evaluated using 2 × 2 contingency tables. Fisher exact and McNemar tests were used for a comparison of the different categories of CCHD, and p < 0.05 vs. controls considered to be statistically significant.Results57% of patients were male, mean age of 36.3 years. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the S-ICD screening tool were 95%, 79%, 59% and 98%, respectively, for controls, and 84%, 79%, 76% and 86%, respectively, in patients with CCHD (p = 0.0001).ConclusionThe S-ICD screening tool was comparatively more sensitive in normal controls but less specific in both CCHD patients and controls; a possible explanation for the reported high incidence of inappropriate S-ICD shocks. Thus, we propose a pre-implant screening device using the S-ICD sensing algorithm to minimise false exclusion and selection, and hence minimise potentially inappropriate shocks. |
| Databáze: | OpenAIRE |
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