© 2004 by European Society of Cardiology
REVIEW
Performance of a dual-chamber implantable defibrillator algorithm for discrimination of ventricular from supraventricular tachycardia
aDepartment of Cardiac Pacing and Electrophysiology Lille University Hospital, France; bGuidant CRM Rueil-Malmaison, France; cDepartment of Cardiology CHU La Timone, Marseille, France; dDepartment of Cardiology CHU Gabriel Montpied, Clermont Ferrand, France; eDepartment of Cardiology CHU Michalon, Grenoble, France; fDepartment of Cardiology CHU A. de Villeneuve, Montpellier, France
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 ViewTM 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 V rate A rate. 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 V rate A rate 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.
Key Words: dual-chamber ICD, ventricular tachycardia, supraventricular tachycardia, tachycardia detection algorithms
*Corresponding author. Service de Cardiologie A, Hôpital Cardiologique, Boulevard du Pr J. Leclercq - CHR & U 59037 Lille Cedex, France. Tel.: +33-3-20-44-50-38; fax: +33-3-20-44-68-98. E-mail address: c-kouakam@chru-lille.fr (C. Kouakam)
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