Implantable cardioverter-defibrillator therapy in the absence of significant symptoms. Rhythm diagnosis and management aided by stored electrogram analysis
| Autor: | David J. Callans, Bruce G. Hook, Belinda T. Flores, Francis E. Marchlinski, Robert B. Kleiman |
|---|---|
| Rok vydání: | 1993 |
| Předmět: |
Tachycardia
Male medicine.medical_specialty Time Factors medicine.medical_treatment Ventricular tachycardia Electrocardiography Physiology (medical) Internal medicine Atrial Fibrillation medicine Tachycardia Supraventricular Humans Bundle branch block medicine.diagnostic_test business.industry Atrial fibrillation Signal Processing Computer-Assisted Equipment Design Middle Aged medicine.disease Implantable cardioverter-defibrillator Defibrillators Implantable Antitachycardia Pacing Cardiology Tachycardia Ventricular Female Supraventricular tachycardia medicine.symptom Cardiology and Cardiovascular Medicine business Follow-Up Studies |
| Zdroj: | Circulation. 87(6) |
| ISSN: | 0009-7322 |
| Popis: | BACKGROUND This report describes the value of stored ventricular electrogram analysis in the diagnosis and management of patients experiencing minimal or no symptoms before implantable cardioverter-defibrillator (ICD) therapy. METHODS AND RESULTS The study population included 48 patients who received the Cadence Tiered Therapy Defibrillator System, an investigational third-generation ICD with ventricular electrogram storage capabilities. Criteria for arrhythmia diagnosis were based on analysis of the electrogram rate, RR interval variability, and morphology. Twenty-nine of the 48 patients (60%) experienced at least one episode of antitachycardia pacing or shock (one shock or more in 25 of 29 patients) that was preceded by minimal or no symptoms during a mean follow-up of 15.1 +/- 7.8 months. There were 194 tachycardia episodes registered by the device, including 101 for which ventricular electrograms were stored and available for analysis. Of the 101 stored electrograms, 74 were classified as ventricular tachycardia (VT), 24 as non-VT rhythms (atrial fibrillation, 13; supraventricular tachycardia, six; rate-sensing lead disruption, four; T wave oversensing, one), and only three as indeterminate rhythms. Based on the electrogram analysis, changes in tachycardia detection criteria and/or antiarrhythmic drug regimens were implemented and were associated with a reduction in the number of device responses for non-VT rhythms from 24 during the initial study period to three during 11.0 +/- 7.2 months of additional follow-up. CONCLUSIONS ICD responses in the absence of symptoms are relatively common in third-generation devices with antitachycardia pacing capabilities. Despite potential limitations such as the effect of bundle branch block on the electrogram morphology during supraventricular tachycardia, the availability of electrogram storage capabilities allowed a presumptive diagnosis of the events precipitating asymptomatic device responses. Device reprogramming based on analysis of stored electrograms was associated with a dramatic reduction in the incidence of ICD responses for non-VT rhythms. |
| Databáze: | OpenAIRE |
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