Dual-chamber versus single-chamber detection enhancements for implantable defibrillator rhythm diagnosis: The detect supraventricular tachycardia study

Paul Andrew Friedman, Robyn L. McClelland, William R. Bamlet, Helbert Acosta, David Kessler, Thomas M. Munger, Neal G. Kavesh, Mark Wood, Emile Daoud, Ali Massumi, Claudio Schuger, Stephen Shorofsky, Bruce Wilkoff, Michael Glikson

Research output: Contribution to journalArticle

198 Citations (Scopus)

Abstract

BACKGROUND - Delivery of inappropriate shocks caused by misdetection of supraventricular tachycardia (SVT) remains a substantial complication of implanted cardioverter/defibrillator (ICD) therapy. Whether use of optimally programmed dual-chamber ICDs lowers this risk compared with that in single-chamber ICDs is not clear. METHODS AND RESULTS - Subjects with a clinical indication for ICD (n=400) at 27 participating centers received dual-chamber ICDs and were randomly assigned to strictly defined optimal single- or dual-chamber detection in a single-blind manner. Programming minimized ventricular pacing. The primary end point was the proportion of SVT episodes inappropriately detected from the time of programming until crossover or end of study. On a per-episode basis, 42% of the episodes in the single-chamber arm and 69% of the episodes in the dual-chamber arm were due to SVT. Mortality (3.5% in both groups) and early study withdrawal (14% single-chamber, 11% dual-chamber) were similar in both groups. The rate of inappropriate detection of SVT was 39.5% in the single-chamber detection arm compared with 30.9% in the dual-chamber arm. The odds of inappropriate detection were decreased by almost half with the use of the dual-chamber detection enhancements (odds ratio, 0.53; 95% confidence interval, 0.30 to 0.94; P=0.03). CONCLUSIONS - Dual-chamber ICDs, programmed to optimize detection enhancements and to minimize ventricular pacing, significantly decrease inappropriate detection.

Original languageEnglish (US)
Pages (from-to)2871-2879
Number of pages9
JournalCirculation
Volume113
Issue number25
DOIs
StatePublished - Jun 2006

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Supraventricular Tachycardia
Implantable Defibrillators
Defibrillators
Shock
Odds Ratio
Confidence Intervals
Mortality
Therapeutics

Keywords

  • Arrhythmia
  • Defibrillation
  • Heart arrest
  • Tachyarrhythmias

ASJC Scopus subject areas

  • Physiology
  • Cardiology and Cardiovascular Medicine

Cite this

Dual-chamber versus single-chamber detection enhancements for implantable defibrillator rhythm diagnosis : The detect supraventricular tachycardia study. / Friedman, Paul Andrew; McClelland, Robyn L.; Bamlet, William R.; Acosta, Helbert; Kessler, David; Munger, Thomas M.; Kavesh, Neal G.; Wood, Mark; Daoud, Emile; Massumi, Ali; Schuger, Claudio; Shorofsky, Stephen; Wilkoff, Bruce; Glikson, Michael.

In: Circulation, Vol. 113, No. 25, 06.2006, p. 2871-2879.

Research output: Contribution to journalArticle

Friedman, PA, McClelland, RL, Bamlet, WR, Acosta, H, Kessler, D, Munger, TM, Kavesh, NG, Wood, M, Daoud, E, Massumi, A, Schuger, C, Shorofsky, S, Wilkoff, B & Glikson, M 2006, 'Dual-chamber versus single-chamber detection enhancements for implantable defibrillator rhythm diagnosis: The detect supraventricular tachycardia study', Circulation, vol. 113, no. 25, pp. 2871-2879. https://doi.org/10.1161/CIRCULATIONAHA.105.594531
Friedman, Paul Andrew ; McClelland, Robyn L. ; Bamlet, William R. ; Acosta, Helbert ; Kessler, David ; Munger, Thomas M. ; Kavesh, Neal G. ; Wood, Mark ; Daoud, Emile ; Massumi, Ali ; Schuger, Claudio ; Shorofsky, Stephen ; Wilkoff, Bruce ; Glikson, Michael. / Dual-chamber versus single-chamber detection enhancements for implantable defibrillator rhythm diagnosis : The detect supraventricular tachycardia study. In: Circulation. 2006 ; Vol. 113, No. 25. pp. 2871-2879.
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abstract = "BACKGROUND - Delivery of inappropriate shocks caused by misdetection of supraventricular tachycardia (SVT) remains a substantial complication of implanted cardioverter/defibrillator (ICD) therapy. Whether use of optimally programmed dual-chamber ICDs lowers this risk compared with that in single-chamber ICDs is not clear. METHODS AND RESULTS - Subjects with a clinical indication for ICD (n=400) at 27 participating centers received dual-chamber ICDs and were randomly assigned to strictly defined optimal single- or dual-chamber detection in a single-blind manner. Programming minimized ventricular pacing. The primary end point was the proportion of SVT episodes inappropriately detected from the time of programming until crossover or end of study. On a per-episode basis, 42{\%} of the episodes in the single-chamber arm and 69{\%} of the episodes in the dual-chamber arm were due to SVT. Mortality (3.5{\%} in both groups) and early study withdrawal (14{\%} single-chamber, 11{\%} dual-chamber) were similar in both groups. The rate of inappropriate detection of SVT was 39.5{\%} in the single-chamber detection arm compared with 30.9{\%} in the dual-chamber arm. The odds of inappropriate detection were decreased by almost half with the use of the dual-chamber detection enhancements (odds ratio, 0.53; 95{\%} confidence interval, 0.30 to 0.94; P=0.03). CONCLUSIONS - Dual-chamber ICDs, programmed to optimize detection enhancements and to minimize ventricular pacing, significantly decrease inappropriate detection.",
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T1 - Dual-chamber versus single-chamber detection enhancements for implantable defibrillator rhythm diagnosis

T2 - The detect supraventricular tachycardia study

AU - Friedman, Paul Andrew

AU - McClelland, Robyn L.

AU - Bamlet, William R.

AU - Acosta, Helbert

AU - Kessler, David

AU - Munger, Thomas M.

AU - Kavesh, Neal G.

AU - Wood, Mark

AU - Daoud, Emile

AU - Massumi, Ali

AU - Schuger, Claudio

AU - Shorofsky, Stephen

AU - Wilkoff, Bruce

AU - Glikson, Michael

PY - 2006/6

Y1 - 2006/6

N2 - BACKGROUND - Delivery of inappropriate shocks caused by misdetection of supraventricular tachycardia (SVT) remains a substantial complication of implanted cardioverter/defibrillator (ICD) therapy. Whether use of optimally programmed dual-chamber ICDs lowers this risk compared with that in single-chamber ICDs is not clear. METHODS AND RESULTS - Subjects with a clinical indication for ICD (n=400) at 27 participating centers received dual-chamber ICDs and were randomly assigned to strictly defined optimal single- or dual-chamber detection in a single-blind manner. Programming minimized ventricular pacing. The primary end point was the proportion of SVT episodes inappropriately detected from the time of programming until crossover or end of study. On a per-episode basis, 42% of the episodes in the single-chamber arm and 69% of the episodes in the dual-chamber arm were due to SVT. Mortality (3.5% in both groups) and early study withdrawal (14% single-chamber, 11% dual-chamber) were similar in both groups. The rate of inappropriate detection of SVT was 39.5% in the single-chamber detection arm compared with 30.9% in the dual-chamber arm. The odds of inappropriate detection were decreased by almost half with the use of the dual-chamber detection enhancements (odds ratio, 0.53; 95% confidence interval, 0.30 to 0.94; P=0.03). CONCLUSIONS - Dual-chamber ICDs, programmed to optimize detection enhancements and to minimize ventricular pacing, significantly decrease inappropriate detection.

AB - BACKGROUND - Delivery of inappropriate shocks caused by misdetection of supraventricular tachycardia (SVT) remains a substantial complication of implanted cardioverter/defibrillator (ICD) therapy. Whether use of optimally programmed dual-chamber ICDs lowers this risk compared with that in single-chamber ICDs is not clear. METHODS AND RESULTS - Subjects with a clinical indication for ICD (n=400) at 27 participating centers received dual-chamber ICDs and were randomly assigned to strictly defined optimal single- or dual-chamber detection in a single-blind manner. Programming minimized ventricular pacing. The primary end point was the proportion of SVT episodes inappropriately detected from the time of programming until crossover or end of study. On a per-episode basis, 42% of the episodes in the single-chamber arm and 69% of the episodes in the dual-chamber arm were due to SVT. Mortality (3.5% in both groups) and early study withdrawal (14% single-chamber, 11% dual-chamber) were similar in both groups. The rate of inappropriate detection of SVT was 39.5% in the single-chamber detection arm compared with 30.9% in the dual-chamber arm. The odds of inappropriate detection were decreased by almost half with the use of the dual-chamber detection enhancements (odds ratio, 0.53; 95% confidence interval, 0.30 to 0.94; P=0.03). CONCLUSIONS - Dual-chamber ICDs, programmed to optimize detection enhancements and to minimize ventricular pacing, significantly decrease inappropriate detection.

KW - Arrhythmia

KW - Defibrillation

KW - Heart arrest

KW - Tachyarrhythmias

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