Entropy estimation of 9 ventricular intervals before ICD shocks accurately distinguished atrial fibrillation from ventricular arrhythmias (ROC AUC 0.98; 95% CI 0.93-1.0).
Observational (n=119)
Blinded adjudication
Yes
Does entropy estimation of ventricular intervals before ICD shocks accurately distinguish atrial fibrillation from ventricular tachycardia/ventricular fibrillation in patients with primary prevention ICDs?
Entropy estimation of ventricular intervals provides highly accurate discrimination between atrial fibrillation and ventricular arrhythmias, offering a potential strategy to reduce inappropriate ICD shocks.
Effect estimate: ROC AUC 0.98 (95% CI 0.93-1.0)
BACKGROUND: Implantable cardioverter-defibrillators (ICDs), the first line of therapy for preventing sudden cardiac death in high-risk patients, deliver appropriate shocks for termination of ventricular tachycardia (VT)/ventricular fibrillation. A common shortcoming of ICDs is imperfect rhythm discrimination, resulting in the delivery of inappropriate shocks for atrial fibrillation (AF). An underexplored area for rhythm discrimination is the difference in dynamic properties between AF and VT/ventricular fibrillation. We hypothesized that the higher entropy of rapid cardiac rhythms preceding ICD shocks distinguishes AF from VT/ventricular fibrillation. METHODS AND RESULTS: In a multicenter, prospective, observational study of patients with primary prevention ICDs, 119 patients received shocks from ICDs with stored, retrievable intracardiac electrograms. Blinded adjudication revealed shocks were delivered for VT/ventricular fibrillation (62%), AF (23%), and supraventricular tachycardia (15%). Entropy estimation of only 9 ventricular intervals before ICD shocks accurately distinguished AF (receiver operating characteristic curve area, 0.98; 95% confidence intervals, 0.93-1.0) and outperformed contemporary ICD rhythm discrimination algorithms. CONCLUSIONS: This new strategy for AF discrimination based on entropy estimation expands on simpler concepts of variability, performs well at fast heart rates, and has potential for broad clinical application.
DeMazumder et al. (Sat,) conducted a observational in Patients with primary prevention ICDs receiving shocks (n=119). Entropy estimation of ventricular intervals vs. Contemporary ICD rhythm discrimination algorithms was evaluated on Discrimination of atrial fibrillation from ventricular tachycardia/ventricular fibrillation (ROC AUC 0.98, 95% CI 0.93-1.0). Entropy estimation of 9 ventricular intervals before ICD shocks accurately distinguished atrial fibrillation from ventricular arrhythmias (ROC AUC 0.98; 95% CI 0.93-1.0).