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Are cutaneously derived electrocardiography signals reliable surrogates for subcutaneous sensing algorithm testing?

<h5>Introduction</h5> A subcutaneous (SQ) defibrillator is a viable alternative to transvenous defibrillators in many patients. In efforts to develop a cutaneous (Q) database to verify and validate an SQ sensing algorithm, we compared the electrocardiography (ECG) characteristics of the SQ and Q signals simultaneously.</P><h5>Methods</h5> Fifteen pigs underwent general anesthesia in the dorsal recumbent position. The SQ pocket for the can was made in the fourth to sixth intercostal space along the left midaxillary line. A small incision left lateral to the xiphoid was created; and using a tool, a multielectrode lead with coil was tunneled from the SQ pocket to this incision. Next, another small incision 8 to 10 cm superior to the xiphoid incision was made along the left sternum. The lead was then tunneled from the xiphoid incision along the parasternum superiorly. The lead body was sutured with a sleeve at the xiphoid position, and the distal tip was sutured to the underlying muscle at the superior parasternum. The lead was attached to the can in the midaxillary pocket, and all incisions were closed. Q conductive adhesive ECG electrodes were placed directly over 3 SQ electrodes. The Q and SQ electrodes were then connected to a multichannel TEAC digital recording system. Three minutes of sinus rhythm data were obtained, and the QRS complexes were analyzed across 3 left chest bipolar vectors (1-3). Average QRS and T wave amplitude values were generated for each vector by analyzing 10 contiguous cardiac cycles. QRS:T ratios were calculated using the averaged values.</P><h5>Results</h5> The mean QRS:T ratio directly correlated between the Q and SQ space when measured simultaneously in vectors 1 to 3 ( r = 0.674, r = 0.951, and r = 0.988, respectively). The measured SQ QRS amplitudes strongly correlated with the Q signal in vectors 1 to 3 ( r = 0.92, r = 0.94, and r = 0.92, respectively). There was no significant difference in measured QRS amplitude between Q and SQ signals in any vector.</P><h5>Conclusions</h5> Surface QRS, T wave, and their ratio correlate with the SQ space directly underlying and across various left chest vectors. Cutaneous ECG signals are reliable surrogates for the SQ ECG in the same location and vectors.</P> http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Journal of Electrocardiology Elsevier

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