Wiles, B M and Roberts, P R and Acharyya, Amit and Allavatam, V and Wilson, D G and Vemishetty, N and Morgan, J M
(2018)
P911Universal SICD eligibility: eliminating the need for preimplant screening using mathematical vector rotation and a gradient filter.
EP Europace, 20.
pp. 175176.
ISSN 10995129
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Abstract
SICD eligibility is determined by ECG morphology across three sensing vectors; primary (P), secondary (S) and alternate (A). Small R:T ratios and low amplitude signals confer an unacceptable risk of oversensing and are unsuitable. The vector score is a composite measure of signal amplitude and R:T ratio calculated using an SICD simulator. Eligibility requires a single vector to score > 100. Around 5% of ICD patients have no suitable vector, this rises to 1316% in some patient groups (ACHD, hypertrophic cardiomyopathy). Mathematical vector rotation is a novel technique which can generate vectors, at any given angle of observation, using signal recorded in the current SICD position. Vector rotation alters the relative amplitudes of both R and T such that for any individual, the largest R wave vector (Rmax) and the smallest T wave vector (Tmin) can be generated. We hypothesise that combining these signals, using a gradient filter to identify periods of rapidly changing signal amplitude, will significantly increase both R:T ratio and vector scores. Application of this programming to a cohort of patients, who are currently SICD ineligible, has the potential to produce universal device eligibility.
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