Key result
Morphology discrimination in dual-chamber ICDs improved sensitivity for fast VT detection from ~82% to ~94% and maintained 96% sensitivity in slow VT zones, with 94.8% specificity.
Why the study?
Does a morphology discrimination algorithm improve the sensitivity and specificity of ventricular tachycardia detection in patients with dual-chamber ICDs?
Observational (n=58)
Does a morphology discrimination algorithm improve the sensitivity and specificity of ventricular tachycardia detection in patients with dual-chamber ICDs?
The use of a morphology discrimination algorithm in dual-chamber ICDs significantly improves the specificity and sensitivity of detecting both slow and fast ventricular tachycardias.
May enhance VT detection in dual-chamber ICDs; leaves open need for randomized confirmation before practice change.
AIMS: Morphology discrimination (MD) is an algorithm based on QRS morphology analysis, that can be used alone or in various combinations with other discriminators in order to diagnose ventricular tachycardia (VT) [the implantable cardioverter-defibrillator (ICD) may be set to diagnose VT if 'Any' or 'All' the discriminators indicate VT)]. METHODS AND RESULTS: We evaluated the contribution of MD in terms of Specificity (SP) and Sensitivity (SE) of rhythm discrimination in slow and fast VT zones (rates <150 bpm and between 150 and 180 bpm, respectively). Detection results (682 spontaneous episodes in 58 patients) were corrected for multiple episodes within a patient (generalized estimating equations method). Rhythm discrimination in slow VT zones was characterized by SE and SP below 80% without MD, while the use of MD alone allowed to enhance SP, maintaining SE at 96%. Use of MD in combination with other discriminators resulted in a decrease in SP (setting 'Any'). In fast VT zones, MD allows an increase in SE for VT detection from around 82% up to approximately 94%, coupled with an SP of 95-96%., although SP is much higher with MD alone (94.8%) than with any other combination (78.4%). Both in slow and fast VT zones, use of multiple discriminators with the setting 'All' resulted in an unacceptable decrease in SE. CONCLUSION: MD in a dual-chamber ICD in combination with a rate branch classification system makes it possible to achieve a very high SP in discriminating detected events both in slow and fast VT zones, while maintaining SE for VT detection.
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Boriani et al. (2008) conducted an observational in Ventricular tachycardia (n=58). Morphology discrimination (MD) algorithm vs. Without MD or other discriminator combinations was evaluated on Specificity and sensitivity of rhythm discrimination in slow and fast ventricular tachycardia zones. Morphology discrimination in dual-chamber ICDs improved sensitivity for fast VT detection from ~82% to ~94% and maintained 96% sensitivity in slow VT zones, with 94.8% specificity.
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