Europace

Europace 2001 3(3):181-186; doi:10.1053/eupc.2001.0171
© 2001 by European Society of Cardiology

This Article Abstract FREE Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in ISI Web of Science Similar articles in PubMed Alert me to new issues of the journal Add to My Personal Archive Download to citation manager Search for citing articles in: ISI Web of Science (12) Request Permissions Disclaimer Google Scholar Articles by Theuns, D. Articles by Jordaens, L. Search for Related Content PubMed PubMed Citation Articles by Theuns, D. Articles by Jordaens, L. Social Bookmarking          What's this?

Initial clinical experience with a new arrhythmia detection algorithm in dual chamber implantable cardioverter defibrillators

D. Theuns, A. P. Klootwijk, G. P. Kimman, T. Szili-Török, J. R. T. C. Roelandt and L. Jordaens

Department of Cardiology Thoraxcentre Rotterdam, The Netherlands

AIM: Inappropriate therapy, due to poor discrimination of supraventricular tachycardia (SVT) from ventricular tachycardia (VT) remains a major problem in patients with an implantable cardioverter defibrillator (ICD). Theoretically, the addition of atrial sensing in discrimination algorithms should improve this differentiation. The aim of the study is to evaluate the performance of a new tachycardia discrimination algorithm, SMART Detection^TM.

METHODS AND RESULTS: Twenty-six patients received a non-thoracotomy ICD system (Phylax AV, Biotronik, Germany). All documented spontaneous arrhythmia episodes were analyzed.

During a mean follow-up of 8 months, a total number of 139 events with stored electrograms were recorded in 12 patients. The final diagnosis was ventricular fibrillation (VF) or polymorphic VT (n=20), monomorphic VT (n=69), SVT (n=26), other ventricular arrhythmia (n=3) and T wave oversensing (n=21). In 6 episodes a dual tachycardia was present. Considering SVT episodes, inappropriate therapy occurred in 2 cases of atrial flutter due to stable ventricular rate (<30 ms), 1 case of atrial tachycardia and 2 cases of sinus tachycardia due to a sudden onset (>10%).

CONCLUSION: With the SMART Detection^TM algorithm, discrimination of VT from SVT achieved a sensitivity of 100%, with an accuracy of 95·6% for all ventricular arrhythmias. In the case of SVT, the algorithm appropriately detected and inhibited therapy in 88% of atrial fibrillation.

Key Words: Implantable defibrillator, dual chamber sensing, atrial fibrillation, inappropriate ICD therapy, detection criteria.

---

Correspondence: L. Jordaens, Thoraxcentre, Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands. E-mail: jordaens{at}card.azr.nl

---

[1] N Engl J Med 1997; 337: 1576–1583 The Antiarrhythmics versus Implantable Defibrillators (AVID) Investigators. A comparison of antiarrhythmic drug therapy with implantable defibrillators in patients resuscitated from near-fatal ventricular arrhythmias.[Abstract/Free Full Text]

[2] Moss AJ, Hall WJ, Cannom DS. Improved survival with an implanted defibrillator in patients coronary artery disease at high risk for ventricular arrhythmia. Multicenter Automatic Defibrillator Implantation Trial Investigators. N Engl J Med 1996; 335: 1933–1940.[Abstract/Free Full Text]

[3] Grimm W, Flores BF, Marchlinski FE. Electrocardiographically documented unnecessary, spontaneous shocks in 241 patients with implantable cardioverter defibrillators. Pacing Clin Electrophysiol 1992; 15: 1667–1673.[CrossRef][Medline]

[4] Osswald S, Cron TA, Sterns L, Alt E, Stotts L, Coenen M. New ICD-technologies: First clinical experience with dual-chamber sensing for differentiation of supraventricular tachyarrhythmias. Pacing Clin Electrophysiol 1998; 21: 292–295.[Medline]

[5] Swerdlow CD, Chen PS, Kass RM, Allard JR, Peter CT. Discrimination of ventricular tachycardia from sinus tachycardia and atrial fibrillation in a tiered-therapy cardioverter-defibrillator. J Am Coll Cardiol 1994; 23: 1342–1355.[Abstract]

[6] Brugada J. Is inappropriate therapy a resolved issue with current implantable cardioverter defibrillators? Am J Cardiol 1999; 83: 40D–44.[Web of Science][Medline]

[7] Duru F, Bauersfeld U, Rahn-Schönbeck M, Candinas R. Morphology discriminator feature for enhanced ventricular tachycardia discrimination in implantable cardioverter defibrillators. Pacing Clin Electrophysiol 2000; 23: 1364–1374.

[8] Schuger CD, Jackson K, Steinman RT, Lehmann MH. Atrial sensing to augment ventricular tachycardia detection by the automatic implantable cardioverter defibrillator: A utility study. Pacing Clin Electrophysiol 1988; 11: 1456–1464.[Medline]

[9] Lavergne T, Daubert JC, Chauvin M, et al. Preliminary clinical experience with the first dual chamber pacemaker defibrillator. Pacing Clin Electrophysiol 1997; 20: 182–188.[CrossRef][Medline]

[10] Swerdlow CD, Ahern T, Chen PS, et al. Underdetection of ventricular tachycardia by algorithms to enhance specificity in a tiered-therapy cardioverter-defibrillator. J Am Coll Cardiol 1994; 24: 416–424.[Abstract]

[11] Weber M, Böcker D, Bänsch D. Efficacy and safety of the initial use of stability and onset criteria in implantable cardioverter defibrillators. J Cardiovasc Electrophysiol 1999; 10: 145–153.[Web of Science][Medline]

[12] Nanthakumar K, Paquette M, Newman D, et al. Inappropriate therapy from atrial fibrillation and sinus tachycardia in automated implantable cardioverter defibrillators. Am Heart J 2000; 139: 797–803.[Web of Science][Medline]

[13] Sticherling C, Schaumann A, Klingenheben T, Hohnloser SH. First worldwide clinical experience with a new dual chamber implantable cardioverter defirbillator. Europace 1999; 1: 96–102.[Abstract/Free Full Text]

[14] Higgins SL, Lee RS, Kramer RL. Stability: An ICD detection criterion for discriminating atrial fibrillation from ventricular tachycardia. J Cardiovasc Electrophysiol 1995; 6: 1081–1088.[CrossRef][Web of Science][Medline]

[15] Swerdlow C, Sheth N, Olson WH, et al. Clinical performance of a pattern based, dual-chamber algorithm for discrimination of ventricular from supraventricular arrhythmias (abstract). Pacing Clin Electrophysiol 1998; 21: 800.

[16] Neuzner J, Pitschner HF, Schlepper M. Programmable VT detection enhancements in implantable cardioverter defibrillator therapy. Pacing Clin Electrophysiol 1995; 18: 539–547.[CrossRef][Medline]

[17] Nair M, Saoudi N, Kroiss D, Letac B. Automatic arrhythmia identification using analysis of the atrioventricular association. Application to a new generation of implantable defibrillators. Participating centers of the automatic recognition of arrhythmia study group. Circulation 1997; 95: 967–973.[Abstract/Free Full Text]

[18] Dijkman B and Wellens HJJ. The VT:SVT discrimination algorithms in dual chamber ICDs-improved but still not perfect automatic arrhythmia detection (abstract). Pacing Clin Electrophysiol 1999; 22: 853.

[19] Wilkoff BL, Kühlkamp V, Gillberg JM, et al. Performance of a dual chamber detection algorithm (PR Logic^TM) based on the worldwide Gem DR clinical results (abstract). Pacing Clin Electrophysiol 1999; 22: 720.

[20] Kühlkamp V, Dörnberger V, Mewis C, Suchalla R, Bosch RF, Seipel L. Clinical experience with the new detection algorithms for atrial fibrillation of a defibrillator with dual chamber sensing and pacing. J Cardiovasc Electrophysiol 1999; 10: 905–915.[Web of Science][Medline]

[21] Kimman GJ, Theuns D, Klootwijk A, Tavernier R, Sutter J, Jordaens L. Comparison of events and survival in dual versus single chamber ICD's. Pacing Clin Electrophysiol 1999; 22: A73 (Abstract).

CiteULike    Connotea    Del.icio.us    What's this?

This article has been cited by other articles:

				S. Tzeis, G. Andrikopoulos, C. Kolb, and P. E. Vardas Tools and strategies for the reduction of inappropriate implantable cardioverter defibrillator shocks Europace, November 1, 2008; 10(11): 1256 - 1265. [Abstract] [Full Text] [PDF]

				P. A. Friedman, R. L. McClelland, W. R. Bamlet, H. Acosta, D. Kessler, T. M. Munger, N. G. Kavesh, M. Wood, E. Daoud, A. Massumi, et al. Dual-Chamber Versus Single-Chamber Detection Enhancements for Implantable Defibrillator Rhythm Diagnosis: The Detect Supraventricular Tachycardia Study Circulation, June 27, 2006; 113(25): 2871 - 2879. [Abstract] [Full Text] [PDF]

				D. A.M.J. Theuns, A. P. J. Klootwijk, D. M. Goedhart, and L. J.L.M. Jordaens Prevention of inappropriate therapy in implantable cardioverter-defibrillators: Results of a prospective, randomized study of tachyarrhythmia detection algorithms J. Am. Coll. Cardiol., December 21, 2004; 44(12): 2362 - 2367. [Abstract] [Full Text] [PDF]

				C. Kouakam, S. Kacet, J.-R. Hazard, A. Ferraci, H. Mansour, P. Defaye, J.-M. Davy, M. Lambiez, and on behalf of the Ventak AV Investigators Performance of a dual-chamber implantable defibrillator algorithm for discrimination of ventricular from supraventricular tachycardia Europace, January 1, 2004; 6(1): 32 - 42. [Abstract] [Full Text] [PDF]

				E. Aliot, Rém. Nitzsché, and A. Ripart Arrhythmia detection by dual-chamber implantable cardioverter defibrillators: A review of current algorithms Europace, January 1, 2004; 6(4): 273 - 286. [Abstract] [Full Text] [PDF]

				D. A. M. J. Theuns, J. C. J. Res, and L. J. Jordaens Home monitoring in ICD therapy: future perspectives Europace, January 1, 2003; 5(2): 139 - 142. [Abstract] [PDF]

This Article Abstract FREE Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in ISI Web of Science Similar articles in PubMed Alert me to new issues of the journal Add to My Personal Archive Download to citation manager Search for citing articles in: ISI Web of Science (12) Request Permissions Disclaimer Google Scholar Articles by Theuns, D. Articles by Jordaens, L. Search for Related Content PubMed PubMed Citation Articles by Theuns, D. Articles by Jordaens, L. Social Bookmarking          What's this?