A new method to investigate the response to the morphology discrimination algorithm in patients with ICD
| Autor: | Christoph Stellbrink, Peter Hanrath, Frank Birkenhauer, Jörg O. Schwab, Rainer Schimpf, Johannes Brachmann, Anil-Martin Sinha, Volker Schibgilla, Ole A. Breithardt |
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| Rok vydání: | 2007 |
| Předmět: |
Male
Tachycardia medicine.medical_treatment Supraventricular Tachyarrhythmias Ventricular tachycardia Sensitivity and Specificity Electrocardiography Tachycardia Supraventricular Humans Medicine Sinus rhythm In patient Heart Atria cardiovascular diseases Chi-Square Distribution Atrial pacing business.industry Middle Aged medicine.disease Implantable cardioverter-defibrillator Defibrillators Implantable Treatment Outcome ROC Curve Exercise Test Linear Models cardiovascular system Female Implant medicine.symptom Cardiology and Cardiovascular Medicine business Algorithm Algorithms Follow-Up Studies |
| Zdroj: | International Journal of Cardiology. 114:323-331 |
| ISSN: | 0167-5273 |
| DOI: | 10.1016/j.ijcard.2006.01.021 |
| Popis: | Background Inappropriate therapy for supraventricular tachyarrhythmia is still a major problem in implantable cardioverter defibrillators (ICD). The morphology discrimination algorithm compares the morphology of a tachycardia electrogram with a stored template on a beat-to-beat basis. However, algorithm responders could not yet be identified prior to the occurrence of first tachycardia episodes. We analyzed whether rapid atrial pacing and/or exercise testing can be used for identification of responders and compared the results with ICD detected tachycardia. Methods 22 patients (16 male, 61±14 years) with dual-chamber ICDs have been enrolled. Patients underwent a standardized bicycle exercise testing and an atrial pacing protocol. For both tests, morphology match scores of 8 consecutive beats were analyzed for each 10-bpm-step increment above sinus rhythm. Patients were categorized as responders, if morphology match was ≥90% of tested heart rates. During follow-up, ICD stored episodes with morphology discrimination activated were evaluated. Results There were no significant differences between morphology match (85±29% vs. 84±27%) and linear regression slope B (−0.19±0.87 vs. −0.20±0.48) during exercise testing and atrial pacing. 16 patients (73%) were classified as responders. During follow-up (739±338 days) 121 sustained supraventricular ( n =88) and ventricular tachycardia ( n =33) were detected in 10 patients (45%). Specificity for tachycardia discrimination was 78% overall, 100% in responders and 22% in non-responders. Conclusion Exercise testing and atrial pacing were equally suitable for identification of patients who seem to respond to the morphology discrimination algorithm with a high specificity for ventricular tachycardia discrimination. Thus, morphology match tests are suggested to optimize tachycardia discrimination and to reduce inadequate therapies. |
| Databáze: | OpenAIRE |
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