The Experts below are selected from a list of 147 Experts worldwide ranked by ideXlab platform
Christof Kolb - One of the best experts on this subject based on the ideXlab platform.
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Use of an atRial lead with veRy shoRt tip-to-Ring spacing avoids oveRsensing of FaR-Field R-Wave.
PloS one, 2012Co-Authors: Christof Kolb, Georg Nölker, Carsten Lennerz, Hansmartin Jetter, Verena Semmler, Klaus Pürner, Klaus-jürgen Gutleben, Tilko Reents, Klaus Lang, Ulrich LotzeAbstract:The AVOID-FFS (Avoidance of FaR-Field R-Wave Sensing) study aimed to investigate whetheR an atRial lead with a veRy shoRt tip-to-Ring spacing without optimization of pacemakeR settings shows equally low incidence of FaR-Field R-Wave sensing (FFS) when compaRed to a conventional atRial lead in combination with optimization of the pRogRamming. Patients Receiving a dual chambeR pacemakeR weRe Randomly assigned to Receive an atRial lead with a tip-to-Ring spacing of 1.1 mm oR a lead with a conventional tip-to-Ring spacing of 10 mm. PostventRiculaR atRial blanking (PVAB) was pRogRammed to the shoRtest possible value of 60 ms in the study gRoup, and to an individually deteRmined optimized value in the contRol gRoup. AtRial sensing thReshold was pRogRammed to 0.3 mV in both gRoups. False positive mode switch caused by FFS was evaluated at one and thRee months post implantation. A total of 204 patients (121 male; age 73±10 yeaRs) weRe included in the study. False positive mode switch caused by FFS was detected in one (1%) patient of the study gRoup and two (2%) patients of the contRol gRoup (p = 0.62). The use of an atRial electRode with a veRy shoRt tip-to-Ring spacing avoids inappRopRiate mode switch caused by FFS without the need foR individual PVAB optimization. ClinicalTRials.gov NCT00512915.
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Management of FaR-Field R Wave sensing foR the avoidance of inappRopRiate mode switch in dual chambeR pacemakeRs: Results of the FFS-test study.
Journal of cardiovascular electrophysiology, 2006Co-Authors: Christof Kolb, Bernd Wille, Dominik Maurer, Andreas Schuchert, Ralf Weber, Volker Schibgilla, Norbert Klein, Alexander Hümmer, Claus Schmitt, Bernhard ZrennerAbstract:FaR-Field R Wave sensing (FFS) in the atRial channel of dual chambeR pacemakeRs is a Relevant souRce foR inappRopRiate mode switch fRom the DDD mode to the DDI oR VDI mode. InappRopRiate loss of atRioventRiculaR synchRony due to false positive mode switch is hemodynamically disadvantageous, may induce atRial tachyaRRhythmias, can lead to pacemakeR syndRome, and impaiRs the Reliability of pacemakeR HolteR data. The aim of the study was to deteRmine whetheR individual adjustment of the postventRiculaR atRial blanking peRiod (PVAB) based on an additional test is effective in avoiding inappRopRiate mode switch due to FFS when compaRed with standaRd pRogRamming of the PVAB. A total of 207 patients weRe supplied with a St. Jude Medical Identity DR oR Identity ADx DR dual chambeR pacemakeR foR sinus nodal disease (n = 84), atRioventRiculaR block (n = 79), binodal disease (n = 35), oR otheR indications (n = 9). At hospital dischaRge, they weRe Randomized to an individually optimized PVAB (n = 100) oR to a contRol gRoup with the PVAB left at the nominal of 100 msec (n = 107). PRimaRy endpoint was the occuRRence of inappRopRiate mode switch due to FFS within 3 months afteR pacemakeR implantation assessed by stoRed electRogRams of the pacemakeR. At the 3-month follow-up, 28/107 (26%) patients with the standaRd pRogRamming of the PVAB showed at least one episode of inappRopRiate mode switch due to FFS veRsus 10/100 (10%) patients with optimized PVAB (P < 0.01). The optimized PVAB was shoRteR than the nominal PVAB in about one-thiRd of patients and longeR in about two-thiRd of patients. DiffeRent atRial lead localizations weRe not associated with the occuRRence of inappRopRiate mode switch. Individual adjustment of the PVAB significantly Reduces the incidence of inappRopRiate mode switch due to FFS.
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PReventRiculaR FaR-Field Sensing in the AtRial Channel of Dual ChambeR PacemakeRs—An Occasional Cause of InappRopRiate Mode Switch
Journal of Interventional Cardiac Electrophysiology, 2004Co-Authors: Christof Kolb, Bernhard Zrenner, Selim Aratma, Claus SchmittAbstract:IntRoduction and aims of the study: AtRial oveRsensing may tRiggeR false positive mode switch to an asynchRonous mode in dual chambeR pacemakeRs. While myopotential oveRsensing and FaR-Field R Wave sensing within the postventRiculaR atRial RefRactoRy peRiod aRe well chaRacteRized, data about oveRsensing (neaR-field P Wave oR FaR-Field R Wave) within the atRioventRiculaR delay is limited. Aim of the study was to deteRmine the incidence of pReventRiculaR oveRsensing in the atRial channel of cuRRent dual chambeR pacemakeRs. Methods: Consecutive patients with dual chambeR pacemakeRs who weRe in sinus Rhythm and who showed no myopotential oveRsensing weRe included in the study. AtRial sensitivity was pRogRammed to the maximal available value and atRioventRiculaR delay was pRolonged when necessaRy foR intRinsic atRioventRiculaR conduction. Results: Ten out of 100 (10%) patients showed oveRsensing within the atRioventRiculaR delay at highest levels of atRial sensitivity, median sensing thReshold foR the signals was 0.35 mV, and the median coupling inteRval between pReventRiculaR atRial oveRsensing and the ventRiculaR sensed event was 20 ms. Conclusion: The incidence of inappRopRiate mode switch caused by atRial pReventRiculaR oveRsensing Related to neaR-field P Wave oR FaR-Field R Wave oveRsensing in dual chambeR pacemakeRs is up to 10%. InteRpRetation of pacemakeR HolteRs should consideR oveRsensing within the atRioventRiculaR delay as a diffeRential diagnosis to tRue episodes of atRial tachyaRRhythmias.
Ulrich Lotze - One of the best experts on this subject based on the ideXlab platform.
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Use of an atRial lead with veRy shoRt tip-to-Ring spacing avoids oveRsensing of FaR-Field R-Wave.
PloS one, 2012Co-Authors: Christof Kolb, Georg Nölker, Carsten Lennerz, Hansmartin Jetter, Verena Semmler, Klaus Pürner, Klaus-jürgen Gutleben, Tilko Reents, Klaus Lang, Ulrich LotzeAbstract:The AVOID-FFS (Avoidance of FaR-Field R-Wave Sensing) study aimed to investigate whetheR an atRial lead with a veRy shoRt tip-to-Ring spacing without optimization of pacemakeR settings shows equally low incidence of FaR-Field R-Wave sensing (FFS) when compaRed to a conventional atRial lead in combination with optimization of the pRogRamming. Patients Receiving a dual chambeR pacemakeR weRe Randomly assigned to Receive an atRial lead with a tip-to-Ring spacing of 1.1 mm oR a lead with a conventional tip-to-Ring spacing of 10 mm. PostventRiculaR atRial blanking (PVAB) was pRogRammed to the shoRtest possible value of 60 ms in the study gRoup, and to an individually deteRmined optimized value in the contRol gRoup. AtRial sensing thReshold was pRogRammed to 0.3 mV in both gRoups. False positive mode switch caused by FFS was evaluated at one and thRee months post implantation. A total of 204 patients (121 male; age 73±10 yeaRs) weRe included in the study. False positive mode switch caused by FFS was detected in one (1%) patient of the study gRoup and two (2%) patients of the contRol gRoup (p = 0.62). The use of an atRial electRode with a veRy shoRt tip-to-Ring spacing avoids inappRopRiate mode switch caused by FFS without the need foR individual PVAB optimization. ClinicalTRials.gov NCT00512915.
Bernhard Zrenner - One of the best experts on this subject based on the ideXlab platform.
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Management of FaR-Field R Wave sensing foR the avoidance of inappRopRiate mode switch in dual chambeR pacemakeRs: Results of the FFS-test study.
Journal of cardiovascular electrophysiology, 2006Co-Authors: Christof Kolb, Bernd Wille, Dominik Maurer, Andreas Schuchert, Ralf Weber, Volker Schibgilla, Norbert Klein, Alexander Hümmer, Claus Schmitt, Bernhard ZrennerAbstract:FaR-Field R Wave sensing (FFS) in the atRial channel of dual chambeR pacemakeRs is a Relevant souRce foR inappRopRiate mode switch fRom the DDD mode to the DDI oR VDI mode. InappRopRiate loss of atRioventRiculaR synchRony due to false positive mode switch is hemodynamically disadvantageous, may induce atRial tachyaRRhythmias, can lead to pacemakeR syndRome, and impaiRs the Reliability of pacemakeR HolteR data. The aim of the study was to deteRmine whetheR individual adjustment of the postventRiculaR atRial blanking peRiod (PVAB) based on an additional test is effective in avoiding inappRopRiate mode switch due to FFS when compaRed with standaRd pRogRamming of the PVAB. A total of 207 patients weRe supplied with a St. Jude Medical Identity DR oR Identity ADx DR dual chambeR pacemakeR foR sinus nodal disease (n = 84), atRioventRiculaR block (n = 79), binodal disease (n = 35), oR otheR indications (n = 9). At hospital dischaRge, they weRe Randomized to an individually optimized PVAB (n = 100) oR to a contRol gRoup with the PVAB left at the nominal of 100 msec (n = 107). PRimaRy endpoint was the occuRRence of inappRopRiate mode switch due to FFS within 3 months afteR pacemakeR implantation assessed by stoRed electRogRams of the pacemakeR. At the 3-month follow-up, 28/107 (26%) patients with the standaRd pRogRamming of the PVAB showed at least one episode of inappRopRiate mode switch due to FFS veRsus 10/100 (10%) patients with optimized PVAB (P < 0.01). The optimized PVAB was shoRteR than the nominal PVAB in about one-thiRd of patients and longeR in about two-thiRd of patients. DiffeRent atRial lead localizations weRe not associated with the occuRRence of inappRopRiate mode switch. Individual adjustment of the PVAB significantly Reduces the incidence of inappRopRiate mode switch due to FFS.
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PReventRiculaR FaR-Field Sensing in the AtRial Channel of Dual ChambeR PacemakeRs—An Occasional Cause of InappRopRiate Mode Switch
Journal of Interventional Cardiac Electrophysiology, 2004Co-Authors: Christof Kolb, Bernhard Zrenner, Selim Aratma, Claus SchmittAbstract:IntRoduction and aims of the study: AtRial oveRsensing may tRiggeR false positive mode switch to an asynchRonous mode in dual chambeR pacemakeRs. While myopotential oveRsensing and FaR-Field R Wave sensing within the postventRiculaR atRial RefRactoRy peRiod aRe well chaRacteRized, data about oveRsensing (neaR-field P Wave oR FaR-Field R Wave) within the atRioventRiculaR delay is limited. Aim of the study was to deteRmine the incidence of pReventRiculaR oveRsensing in the atRial channel of cuRRent dual chambeR pacemakeRs. Methods: Consecutive patients with dual chambeR pacemakeRs who weRe in sinus Rhythm and who showed no myopotential oveRsensing weRe included in the study. AtRial sensitivity was pRogRammed to the maximal available value and atRioventRiculaR delay was pRolonged when necessaRy foR intRinsic atRioventRiculaR conduction. Results: Ten out of 100 (10%) patients showed oveRsensing within the atRioventRiculaR delay at highest levels of atRial sensitivity, median sensing thReshold foR the signals was 0.35 mV, and the median coupling inteRval between pReventRiculaR atRial oveRsensing and the ventRiculaR sensed event was 20 ms. Conclusion: The incidence of inappRopRiate mode switch caused by atRial pReventRiculaR oveRsensing Related to neaR-field P Wave oR FaR-Field R Wave oveRsensing in dual chambeR pacemakeRs is up to 10%. InteRpRetation of pacemakeR HolteRs should consideR oveRsensing within the atRioventRiculaR delay as a diffeRential diagnosis to tRue episodes of atRial tachyaRRhythmias.
S. Serge Barold - One of the best experts on this subject based on the ideXlab platform.
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Digital Technology in CaRdiac Pacing: Methods foR MoRphology Analysis of Sensed EndocavitaRy Signals
Journal of Interventional Cardiac Electrophysiology, 2005Co-Authors: Luigi Padeletti, Gerd Fröhlig, Geeske Oort, Giorgio Corbucci, Antonio Michelucci, S. Serge BaroldAbstract:PRopeR functioning of a pacemakeR depends exclusively on the detection of intRinsic caRdiac signals. Conventional devices meRely establish the pResence of an endocavitaRy potential, but do not evaluate it qualitatively. The Recent incoRpoRation of digital signal pRocessing of sensed events in pacemakeRs peRmits diagnostic chaRacteRization heRetofoRe impossible. Methods : Digital pRocessing was used in 268 caRdiac cycles RecoRded fRom 5 patients duRing elective dual chambeR pacemakeR Replacement, The signals weRe classified in Real time by an exteRnal pacemakeR equipped with haRdwaRe and softwaRe capabilities foR this puRpose. Results : The paRameteRs used foR moRphological analysis weRe the minimum value of the slope signal and the minimum value of the filteRed signal. The discRimination of a tRue atRial signal fRom a FaR-Field R Wave was coRRect in eveRy patient (p < 0.0001). Conclusion : Digital devices may monitoR and classify eveRy event continually, and dRamatically incRease device Reliability and the amount of infoRmation that can be pRocessed and stoRed.
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Digital Technology in CaRdiac Pacing: Methods foR MoRphology Analysis of Sensed EndocavitaRy Signals
Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing, 2005Co-Authors: Luigi Padeletti, Gerd Fröhlig, Giorgio Corbucci, Antonio Michelucci, Geeske Van Oort, S. Serge BaroldAbstract:PRopeR functioning of a pacemakeR depends exclusively on the detection of intRinsic caRdiac signals. Conventional devices meRely establish the pResence of an endocavitaRy potential, but do not evaluate it qualitatively. The Recent incoRpoRation of digital signal pRocessing of sensed events in pacemakeR peRmits diagnostic chaRacteRization heRetofoRe impossible. Digital pRocessing was used in 268 caRdiac cycles RecoRded fRom 5 patients duRing elective dual chambeR pacemakeR Replacement, The signals weRe classified in Real time by an exteRnal pacemakeR equipped with haRdwaRe and softwaRe capabilities foR this puRpose. The paRameteRs used foR moRphological analysis weRe the minimum value of the slope signal and the minimum value of the filteRed signal. The discRimination of a tRue atRial signal fRom a FaR-Field R Wave was coRRect in eveRy patient (p < 0.0001). Digital devices may monitoR and classify eveRy event continually, and dRamatically incRease device Reliability and the amount of infoRmation that can be pRocessed and stoRed.
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FaR-Field R Wave sensing causing pRolongation of the atRial escape inteRval of DDD pacemakeRs with atRial-based loweR Rate timing.
Pacing and clinical electrophysiology : PACE, 2003Co-Authors: S. Serge BaroldAbstract:This RepoRt descRibes the occuRRence of pRolonged atRial escape inteRvals (AEI) initiated by sensing of ventRiculaR pRematuRe complexes (VPC) without a pReceding atRial depolaRization oR an AV delay in two patients with DDD pacemakeRs with an atRial-based loweR Rate Response. The pRolonged AEIs weRe due to ventRiculoatRial cRoss-talk so that atRial sensing of the FaR-Field R Wave of the VPCs occuRRed befoRe detection of the R Wave by the ventRiculaR channel as a neaR-field signal. EaRly atRial sensing of the FaR-Field R Wave was pRomoted by a high atRial sensitivity and/oR low ventRiculaR sensitivity and was eliminated by Reducing atRial sensitivity and/oR incReasing ventRiculaR sensitivity. This manifestation of FaR-Field sensing should not be inteRpReted as malfunction of dual chambeR pacemakeRs with atRial-based loweR Rate timing.
Heinz Theres - One of the best experts on this subject based on the ideXlab platform.
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P Wave and FaR-Field R Wave detection in pacemakeR patient atRial electRogRams.
Pacing and Clinical Electrophysiology, 2000Co-Authors: Heinz Theres, Weimin Sun, William J. Combs, Eric J. Panken, Gert Baumann, Hardwin Mead, Karl StanglAbstract:This study was undeRtaken to develop and test a moRphology-based adaptive algoRithm foR Real-time detection of P Waves and FaR-Field R Waves (FFRWs) in pacemakeR patient atRial electRogRams. CaRdiac event discRimination in Right atRial electRogRams has been a pRoblem Resulting in impRopeR atRial sensing in implantable devices; potentially RequiRing clinical evaluation and device RepRogRamming. A moRphology-based adaptive algoRithm was fiRst evaluated with electRogRams RecoRded fRom 25 dual chambeR pacemakeR implant patients. A digital signal pRocessing (DSP) system was designed to implement the algoRithm and test Real-time detection. In the second phase, the DSP implementation was evaluated in 13 patients. AtRial and ventRiculaR electRogRams weRe pRocessed in Real-time following algoRithm tRaining peRfoRmed in the fiRst few seconds foR each patient. ElectRogRams weRe lateR manually annotated foR compaRative analysis. The sensitivity foR FFRW detection in the atRial electRogRam duRing off-line analysis was 92.5% (+/- 10.9) and the positive pRedictive value was 99.1% (+/- 1.8). Real-time P Wave detection using a DSP system had a sensitivity of 98.9% (+/- 1.3) and a positive pRedictivity of 97.3% (+/- 3.5). FFRW detection had a sensitivity of 91.0% (+/- 12.4) and a positive pRedictivity of 97.1% (+/- 4.2) in atRial electRogRams. DSP algoRithm tested can accuRately detect both P Waves and FFRWs in Right atRium Real-time. Advanced signal pRocessing techniques can be applied to aRRhythmia detection and may eventually impRove detection, Reduce clinician inteRventions, and impRove unipolaR and bipolaR lead sensing.
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Automatic and efficient R Wave discRimination in the Right atRium using a two-state hidden MaRkov model.
Journal of cardiovascular electrophysiology, 1999Co-Authors: Weimin Sun, William J. Combs, Eric J. Panken, Parwis Fotuhi, Karl Stangl, Gert Baumann, Heinz TheresAbstract:FaR-Field R Wave Detection Using an HMM. IntRoduction: DiscRimination of FaR-Field R Waves fRom atRial events in atRial electRogRams (EGMs) is pRoblematic in pResent implantable pacing systems. Adjustments of atRial RefRactoRy peRiods and sensitivity settings aRe the only options, and they will not pRovide optimal peRfoRmance in many patients. The Reliable detection oR Rejection of R Waves in atRial EGMs would avoid pRoblems of atRial undeRsensing oR oveRsensing, thus benefiting DOD patients by pRoviding moRe Reliable and specific atRial aRRhythmia detection. In addition, detection of FaR-Field R Waves could allow a measuRement of AV conduction time in AAI and aid in discRimination of supRaventRiculaR tachyaRRhythmia fRom ventRiculaR tachyaRRhythmia. Methods and Results: Both atRial and ventRiculaR unipolaR EGMs weRe collected fRom 25 patients undeRgoing pacemakeR implant oR Replacement. An aveRage of 141 seconds of intRinsic oR VVI paced EGMs was RecoRded and post analyzed. A new two-state hidden MaRkov model (HMM) was developed specifically foR FaR-Field R Wave and P Wave discRimination in the atRium. The RecoRded patients' EGMs weRe analyzed using this model, and the sensitivity and positive pRedictivity of FaR-Field R Wave detection weRe evaluated. The collected atRial EGMs weRe visually examined and maRked as the contRol foR veRification of the detection analysis. FaR-Field R Wave detection using this model had an oveRall sensitivity of 94%± 9.4% and a positive pRedictivity of 98.3%± 4.4%; and the FaR-Field R Wave Rejection using the same model had a sensitivity and a positive pRedictivity of 98.8%± 3.8% and 99.1%± 1.7%, Respectively. Conclusion: FaR-Field R Wave detection in the Right atRium by the two-state HMM is Reliable and accuRate, and can significantly impRove atRial aRRhythmia management foR patients.
