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First, it means that simple line-drawing exercises aimed at isolating "enhancement technologies" from other biomedical interventions for special precautionary regulation or oversight are destined to be ineffective (pace Anderson 1989).
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Figure 1 A compares typical EGM signals during effective pacing, ineffective pacing due to loss of LV capture, and ineffective pacing due to pseudofusion.
An average correlation >0.9 defined a classification truth of ineffective pacing.
The algorithm classified 540 (100%) of 540 confirmed ineffective paced beats (due to loss of LV capture) as being ineffective.
Table 2 summarizes the sensitivity and specificity of the algorithm for identifying effective vs. ineffective pacing (pseudofusion) for different thresholds of correlation coefficients.
During ineffective pacing due to loss of LV capture or pseudofusion, the EGM immediately after blanking has a positive deflection (R-wave).
For each beat, if the average correlation coefficient between paced and intrinsic templates for the three leads exceeded 0.9, the beat was defined as ineffective pacing; else the beat was defined as effective pacing.
If there is ineffective pacing during sinus rhythm, shorter AV delays, a change in V V delay towards earlier LV activation, or an increase in pacing output may be necessary to ensure more consistent effective capture.
Definition of effective vs. ineffective LV pacing during BV/LV pacing was based on the correlation between paced and intrinsic QRS morphologies in the surface ECG.
The algorithm misclassified 1.8% of the effective LV-paced beats as ineffective LV pacing.
Morphological features of LV cathode RV coil EGMs were analysed to develop a device-based automatic algorithm, which classified each paced beat as effective or ineffective LV pacing.
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Justyna Jupowicz-Kozak
CEO of Professional Science Editing for Scientists @ prosciediting.com