June 1, 1993Circulation
Implantable cardioverter-defibrillator therapy in the absence of significant symptoms. Rhythm diagnosis and management aided by stored electrogram analysis.
Why the study?
Does stored ventricular electrogram analysis improve rhythm diagnosis and reduce inappropriate ICD responses in patients with minimal or no symptoms?
Population
48 patients who received the Cadence Tiered Therapy Defibrillator System
Design
Cohort
Follow-up
mean 15.1 +/- 7.8 months and 11.0 +/- 7.2 months
Authors
Discussion
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Implication
May support electrogram-guided ICD reprogramming to cut inappropriate therapies; leaves open need for randomized confirmation.
Key Points
- This report aims to evaluate the effectiveness of stored ventricular electrogram analysis in managing asymptomatic patients with implantable cardioverter-defibrillators.
- Included 48 patients with the Cadence Tiered Therapy Defibrillator System.
- Analyzed electrogram rates, RR interval variability, and waveform morphology for arrhythmia diagnosis.
- Follow-up period averaged 15.1 months.
- 60% of patients experienced at least one device response, with 25 receiving shocks.
- Of the 101 analyzed stored electrograms, 74 were classified as ventricular tachycardia.
- Device reprogramming significantly reduced ICD responses for non-VT rhythms from 24 to 3 during follow-up.
Structured PICO
Does stored ventricular electrogram analysis improve rhythm diagnosis and reduce inappropriate ICD responses in patients with minimal or no symptoms?
P
Population
48 patients who received the Cadence Tiered Therapy Defibrillator System (an investigational third-generation ICD with ventricular electrogram storage capabilities)
I
Intervention
Stored ventricular electrogram analysis for rhythm diagnosis and subsequent device reprogramming or antiarrhythmic drug changes
O
Outcome
Diagnosis of rhythms precipitating asymptomatic device responses and reduction in non-VT device responses
Stored electrogram analysis in ICDs allows accurate diagnosis of asymptomatic device therapies and enables reprogramming to significantly reduce inappropriate shocks for non-VT rhythms.
Limitations
- effect of bundle branch block on the electrogram morphology during supraventricular tachycardia
Cite This Study
Hook et al. (1993) studied this question.