Key result
RV coil-can and tip-ring configurations achieve ~95% correct morphology classification, outperforming SVC coil-can.
Why the study?
Inappropriate therapy delivery remains a significant concern in ICD management, and the performance of a wavelet-based morphology algorithm across different EGM configurations and body positions needed evaluation.
Does EGM configuration and body position impact the accuracy of wavelet-based tachycardia discrimination in patients with ICDs?
Cross-Sectional (n=28)
Does EGM configuration and body position impact the accuracy of wavelet-based tachycardia discrimination in patients with ICDs?
Absolute Event Rate: 95% vs 58%
p-value: p=<0.001
The SVC coil-can configuration should be avoided when using wavelet-based morphology algorithms in ICDs due to significant variations in morphology scores with changes in body position.
May warrant avoiding SVC coil-can EGM for wavelet discrimination; hypothesis-generating for optimal ICD configurations.
BACKGROUND: Inappropriate therapy delivery is an important concern in the management of patients with implantable cardioverter defibrillators (ICDs). Recently, a morphology-based algorithm (wavelet feature) has been introduced for differentiation of ventricular and supraventricular tachycardia. In this study, we evaluated the performance of the wavelet algorithm using various electrogram (EGM) configurations during different body positions. METHODS: Patients with a single-chamber Medtronic model 7230 ICD (Minneapolis, MN, USA) and a double-coil lead were included. EGM templates were collected during baseline rhythm in supine position for different EGM sources (right ventricular [RV] coil-can, RV coil-superior vena cava [SVC] coil, tip-ring, SVC coil-can). For each EGM configuration, morphologic similarity (match percentage) of EGMs obtained during different body positions (supine, left and right lateral, sitting, standing, walking) were compared with the templates. RESULTS: Twenty-eight patients (24 males; age 58 +/- 17 years) were studied. A total of 9,775 intracardiac EGMs were analyzed. Median match percentage (interquartile range) was 88% (85-94), 88% (82-94), 82% (76-88), and 73 (58-85) for the RV coil-can, RV coil-SVC coil, tip-ring, and SVC coil-can configurations, respectively. Correct classification rates, as defined by match percentage of 70% or higher, were significantly higher with the RV coil-can, RV coil-SVC coil, and tip-ring EGM configurations, as compared to the SVC coil-can configuration (95, 91, and 91 vs 58% > or =70% match percent, P < 0.001). CONCLUSION: Wavelet-based morphology scores in ICDs may change with various body positions. These variations are relatively minor using the nominal configuration (RV coil-can), as well as by using RV coil-SVC coil and tip-ring. However, morphology scores can vary considerably when SVC coil-can is used; therefore, this configuration should be avoided while using the wavelet algorithm.
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Wölber et al. (2006) conducted a cross-sectional in Patients with implantable cardioverter defibrillators (ICDs) (n=28). RV coil-can, RV coil-SVC coil, and tip-ring EGM configurations vs. SVC coil-can configuration was evaluated on Correct classification rate (match percentage ≥70%) (p=<0.001). Correct classification rates of wavelet-based morphology scores were significantly higher with RV coil-can, RV coil-SVC coil, and tip-ring configurations compared to SVC coil-can (95%, 91%, 91% vs 58%; P<0.001).
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