Heart rhythm O2 · 2025
Long-term low-voltage impedance measurements in subcutaneous implantable cardioverter-defibrillators.
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Mugnai Giacomo, Tomasi Luca, Ottaviano Luca, Viani Stefano, Ricciardi Giuseppe, Bianchi Valter, Rella Valeria, De Filippo Paolo, De Bonis Silvana, Rordorf Roberto, Pecora Domenico, Botto Gianluca, Nigro Gerardo, Tola Gianfranco, Caravati Fabrizio, Lovecchio Mariolina, Valsecchi Sergio, Ziacchi Matteo, “S-ICD Rhythm Detect” Investigators
Аннотация
BACKGROUND: High-voltage impedance (HVI), measured during subcutaneous implantable cardioverter-defibrillator (S-ICD) implantation via defibrillation testing or a synchronized shock, is associated with defibrillation efficacy. Recently, S-ICD systems have been upgraded to automatically perform long-term measurements of low-voltage impedance (LVI) using a 1-V subthreshold pulse.
OBJECTIVE: This study evaluated LVI as a surrogate for HVI and described its long-term trends in S-ICD recipients.
METHODS: We analyzed data from 1226 patients who underwent de novo S-ICD implantation across 15 Italian centers. Weekly averages of LVI and HVI were calculated, and agreement between simultaneous measurements was assessed.
RESULTS: Over a median follow-up of 37 months (interquartile range 20-57 months), 373 paired HVI and LVI measurements were analyzed. LVI strongly correlated with HVI (r = 0.90; 95% confidence interval 0.88-0.92; P < .001), with a mean bias of -3 Ω (limits of agreement -21 to 14 Ω). The mean LVI increased significantly during the first 3 months postimplantation (from 59 ± 14 to 76 ± 16 Ω; P < .001) before stabilizing (77 ± 17 Ω; P = .231). Higher LVI values were observed in overweight/obese patients when subcutaneous device positioning and the 3-incision lead deployment technique were used. Similarly, higher values were obtained when significant subcoil fat was observed and the Prospective, RAndomizEd comparison of subcuTaneOus and tRansvenous ImplANtable cardioverter-defibrillator therapy score was ≥90.
CONCLUSION: LVI showed strong agreement with HVI during follow-up, supporting its potential use as a noninvasive surrogate for HVI. LVI increased during the initial postimplantation period and subsequently stabilized, possibly reflecting physiological changes.
OBJECTIVE: This study evaluated LVI as a surrogate for HVI and described its long-term trends in S-ICD recipients.
METHODS: We analyzed data from 1226 patients who underwent de novo S-ICD implantation across 15 Italian centers. Weekly averages of LVI and HVI were calculated, and agreement between simultaneous measurements was assessed.
RESULTS: Over a median follow-up of 37 months (interquartile range 20-57 months), 373 paired HVI and LVI measurements were analyzed. LVI strongly correlated with HVI (r = 0.90; 95% confidence interval 0.88-0.92; P < .001), with a mean bias of -3 Ω (limits of agreement -21 to 14 Ω). The mean LVI increased significantly during the first 3 months postimplantation (from 59 ± 14 to 76 ± 16 Ω; P < .001) before stabilizing (77 ± 17 Ω; P = .231). Higher LVI values were observed in overweight/obese patients when subcutaneous device positioning and the 3-incision lead deployment technique were used. Similarly, higher values were obtained when significant subcoil fat was observed and the Prospective, RAndomizEd comparison of subcuTaneOus and tRansvenous ImplANtable cardioverter-defibrillator therapy score was ≥90.
CONCLUSION: LVI showed strong agreement with HVI during follow-up, supporting its potential use as a noninvasive surrogate for HVI. LVI increased during the initial postimplantation period and subsequently stabilized, possibly reflecting physiological changes.