Key result
The Atrial View dual-chamber ICD detection algorithm demonstrated 99% sensitivity and 89% specificity for discriminating ventricular from supraventricular tachycardia.
Why the study?
Does a dual-chamber ICD detection algorithm accurately discriminate ventricular from supraventricular tachycardia in patients with standard ICD indications?
Observational (n=51)
Open-label
Yes
Does a dual-chamber ICD detection algorithm accurately discriminate ventricular from supraventricular tachycardia in patients with standard ICD indications?
A dual-chamber ICD detection algorithm utilizing atrial and ventricular rate criteria provides high sensitivity and specificity for arrhythmia discrimination, though SVTs with a 1:1 atrioventricular relationship remain challenging.
May aid arrhythmia discrimination in dual-chamber ICDs; leaves open need for randomized validation before practice change.
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 View algorithm, incorporated in a dual-chamber ICD, the Ventak AV (Guidant Inc., St. Paul, Minnesota, USA).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 Vrate>Arate. 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%.Programming of detection criteria based on stability, onset, atrial fibrillation rate threshold and Vrate>Arate 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.
No takes yet. Share an insight, caveat, or question.
Claude Kouakam (2003) conducted an observational in Patients with standard indications for implantable cardioverter defibrillators (n=51). Atrial View dual-chamber detection algorithm in Ventak AV ICD was evaluated on Algorithm sensitivity for discriminating ventricular from supraventricular tachycardia. The Atrial View dual-chamber ICD detection algorithm demonstrated 99% sensitivity and 89% specificity for discriminating ventricular from supraventricular tachycardia.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: