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Circ Arrhythm Electrophysiol. 2020 Feb;13(2):e008092. doi: 10.1161/CIRCEP.119.008092. Epub 2020 Jan 27.

Impedance in the Diagnosis of Lead Malfunction.

Author information

1
Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (C.D.S.).
2
Division of Cardiology, VCU School of Medicine, Richmond, VA (J.N.K., K.A.E.).
3
Medtronic PLC, Mounds View, MN (B.G.).
4
University of Minnesota, Minneapolis (M.W.K.).
5
IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, France (S.P.).
6
Bordeaux University Hospital (CHU), Cardio-Thoracic Unit, Pessac, France (S.P.).

Abstract

Impedance is the ratio of voltage to current in an electrical circuit. Cardiovascular implantable electronic devices measure impedance to assess the structural integrity electrical performance of leads, typically using subthreshold pulses. We review determinants of impedance, how it is measured, variation in clinically measured pacing and high-voltage impedance and impedance trends as a diagnostic for lead failure and lead-device connection problems. We consider the differential diagnosis of abnormal impedance and the approach to the challenging problem of a single, abnormal impedance measurement. Present impedance provides a specific but insensitive diagnostic. For pacing circuits, we review the complementary roles of impedance and more sensitive oversensing diagnostics. Shock circuits lack a sensitive diagnostic. This deficiency is particularly important for insulation breaches, which may go undetected and present with short circuits during therapeutic shocks. We consider new methods for measuring impedance that may increase sensitivity for insulation breaches.

KEYWORDS:

electricity; implantable defibrillator; shock; superior vena cava

PMID:
31985260
DOI:
10.1161/CIRCEP.119.008092

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