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June 1, 1997Pacing and Clinical Electrophysiology

Inadequacy of Qualitative Implantable Cardioverter Defibrillator Electrogram Analysis to Distinguish Supraventricular from Ventricular Tachycardia Due to Electrogram Changes During Normally Conducted Complexes

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Key result

Qualitative analysis of stored ICD electrograms was inadequate to distinguish supraventricular from ventricular tachycardia due to EGM changes during normally conducted complexes.

Population

1 patient with an implantable cardioverter defibrillator (ICD) for ventricular tachycardia (VT)

Design

Case_report

Authors

NHNanette HallettBeth Israel Deaconess Medical CenterKMKevin M. MonahanBoston UniversityDCDavid CasavantBoston Children's Hospital

Discussion

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Implication

Caution in ICD EGM interpretation for tachycardia classification; case report leaves open quantitative discriminator validation.

Key Points

  • To examine whether qualitative analysis of stored implantable cardioverter defibrillator electrograms reliably differentiates supraventricular tachycardia from ventricular tachycardia.
  • Evaluated a patient with an implantable cardioverter defibrillator who received multiple shocks for tachycardia misidentified as ventricular in origin.
  • Conducted a comprehensive electrophysiological study assessing electrogram morphology during sinus rhythm, atrial pacing, and induced supraventricular arrhythmias.
  • Stored electrograms diverged notably from normal sinus rhythm during both atrial pacing and induced supraventricular arrhythmias despite intact, normal conduction.
  • Morphologic changes during supraventricular events closely mimicked ventricular tachycardia electrograms, directly precipitating inappropriate defibrillator shocks.

Study Design

Type

Case Report (n=1)

Structured PICO

P
Population
1 patient with an ICD for VT who received multiple shocks for a tachycardia.
E
Exposure
Electrophysiological study with analysis of electrograms (EGMs) during induced arrhythmias
O
Outcome
Differentiation of supraventricular from ventricular tachycardia

Stored ICD electrograms that differ from sinus rhythm may not reliably indicate ventricular tachycardia, as normally conducted complexes during SVT can also produce altered EGMs.

Limitations

  • Stored EGMs alone may be inadequate to distinguish SVT from VT without complete electrophysiological study.

Cite This Study

Hallett et al. (1997) conducted a case report in Ventricular tachycardia (n=1). Qualitative Implantable Cardioverter Defibrillator Electrogram Analysis was evaluated on Distinguishing supraventricular from ventricular tachycardia. Qualitative analysis of stored ICD electrograms was inadequate to distinguish supraventricular from ventricular tachycardia due to EGM changes during normally conducted complexes.

synapsesocial.com/papers/6aa028e5645fa8fa55ef7ad6https://doi.org/10.1111/j.1540-8159.1997.tb03548.x

Topics

Ventricular arrhythmiasCardiac device therapy
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Detection of Pathological Tachycardia by Analysis of Electrogram Morphology1986 · 82 citations
  2. 2Clinical Performance of the Implantable Cardioverter Defibrillator: Electrocardiographic Documentation of 101 Spontaneous Discharges1991 · 76 citations
  3. 3Paced Beats Following Single Nonsensed Complexes in a “Codependent” Cardioverter Defibrillator and Bradycardia Pacing System: Potential for Ventricular Tachycardia Induction1991 · 28 citations
  4. 4Clinical experience, complications, and survival in 70 patients with the automatic implantable cardioverter/defibrillator.1985 · 452 citations
  5. 5Termination of Malignant Ventricular Arrhythmias with an Implanted Automatic Defibrillator in Human Beings1980 · 1,367 citations