Estimation of the Scope of Transvenous Lead Systems in Implantable Cardioverter Defibrillators

The analysis of intracardiac electrograms (EGM) recorded by transvenous lead systems in implantable cardioverter defibrillators (ICD) often entails assumptions on the scope of the lead system. Based on bioelectric signal modeling and on numerical analysis, we studied quantitatively the scope of unipolar and bipolar lead configurations in ICD. We defined the scope in terms of the mean square difference (MSD) between EGM generated by the whole myocardium, and EGM generated by different families of regions within the myocardium. For unipolar and bipolar lead systems, simulations showed that the smallest myocardial region involving a given value of MSD is characterized by the highest measurement sensitivity. Furthermore, the scope in the ventricles was found to be an order of magnitude smaller for bipolar leads than for unipolar leads. Bioelectric signal modeling combined with numerical analysis constitutes a powerful method to study quantitatively the scope of transvenous lead systems.