Document Detail

Performance of a dual-chamber implantable defibrillator algorithm for discrimination of ventricular from supraventricular tachycardia.
MedLine Citation:
PMID:  14697724     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Inappropriate therapies remain a major problem in patients with implantable cardioverter defibrillators (ICDs). Decreasing the proportion of inappropriate therapies is a major objective. With the addition of atrial detection and advanced algorithms, dual-chamber ICDs are designed to offer better discrimination of ventricular (VT) and supraventricular (SVT) arrhythmias. The present multicentre, open study aimed to evaluate the performance of a dual-chamber detection algorithm, the Atrial View algorithm, incorporated in a dual-chamber ICD, the Ventak AV (Guidant Inc., St. Paul, Minnesota, USA). METHODS AND RESULTS: Fifty-one patients (45 males, 62+/-11 years, ejection fraction 42+/-15%) with standard indications received a Ventak AV ICD which analyzes, within the VT zone RR stability, tachycardia onset, atrial rate and AV relationship. Predischarge enhanced-detection algorithms were prospectively programmed: stability 24 ms, onset 9%, atrial fibrillation threshold 200 beats/min, and Vrate>Arate. An additional sustained rate duration criterion was programmed at least at 30 s. ICDs were interrogated every 3 months or when patients received shocks. A blinded review of electrograms for arrhythmia diagnosis and appropriateness of therapy was performed by 2 experts. Over the follow-up period (12+/-3.6 months), a total of 400 tachycardia episodes was recorded within the VT zone. After the review of stored electrograms, 237 (59%) true positive, 143 (36%) true negative, 17 (4%) false positive and 3 (1%) false negative episodes were diagnosed. Considering the 3 VTs incorrectly detected by the detection algorithms, therapy was delivered in 2 cases after sustained rate duration and 1 VT reverted spontaneously. Inappropriate therapy occurred in 17 cases. All but 1 were related to SVT with 1:1 atrioventricular relationship. Finally, on a per episode basis, the detection algorithm sensitivity was 99% and specificity was 89%. CONCLUSIONS: Programming of detection criteria based on stability, onset, atrial fibrillation rate threshold and Vrate>Arate allows a 99% sensitivity and an 89% specificity in Guidant ICDs. Discrimination of SVT with 1:1 atrioventricular relationship, however, remains a challenge for which new algorithms have to be designed.
Claude Kouakam; Salem Kacet; Jean-René Hazard; Ange Ferraci; Hassan Mansour; Pascal Defaye; Jean-Marc Davy; Marie Lambiez;
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Publication Detail:
Type:  Evaluation Studies; Journal Article; Multicenter Study    
Journal Detail:
Title:  Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology     Volume:  6     ISSN:  1099-5129     ISO Abbreviation:  Europace     Publication Date:  2004 Jan 
Date Detail:
Created Date:  2003-12-30     Completed Date:  2004-06-08     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  100883649     Medline TA:  Europace     Country:  England    
Other Details:
Languages:  eng     Pagination:  32-42     Citation Subset:  IM    
Department of Cardiac Pacing and Electrophysiology, Lille University Hospital, France.
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MeSH Terms
Defibrillators, Implantable / standards*
Diagnosis, Differential
Equipment Design
Middle Aged
Sensitivity and Specificity
Tachycardia, Supraventricular / diagnosis*,  therapy
Ventricular Fibrillation / diagnosis*,  therapy

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