Optimal combination of discriminators for differentiating ventricular from supraventricular tachycardia by dual-chamber defibrillators

Michael Glikson, Charles D. Swerdlow, Osnat T. Gurevitz, Emile Daoud, Kalyanam Shivkumar, Bruce Wilkoff, Tamara Shipman, Paul Andrew Friedman

Research output: Contribution to journalArticle

53 Citations (Scopus)

Abstract

Discriminators for Ventricular/Supraventricular Tachycardia. Introduction: Dual-chamber implantable cardioverter defibrillators (ICDs) use discriminators to differentiate between supraventricular tachycardias (SVTs) and ventricular tachycardias (VT), the accuracy of which may depend on the type and method used. ICDs can combine rate branching of tachyarrhythmias according to their A:V relationship with two SVT-VT discriminators in each rate branch, using ANY (either) or ALL (both) logic. Our goal was to determine the optimal discriminator combination. Methods: Stored electrogram data from 596 spontaneous tachyarrhythmias from 203 patients with Photon DR ICDs were analyzed. Arrhythmias are first classified by the relationship of atrial and ventricular rates (rate branches V < A, V = A, and V > A) followed by additional discriminators: morphology and/or sudden onset if V = A; morphology and/or interval stability if V < A. Data were analyzed for all combinations of ANY and ALL logic. Results: Sensitivity and specificity were calculated for all spontaneous episodes in each analysis. V = A branch: ALL logic produced unacceptably low sensitivity, whereas morphology provided only similar sensitivity but better specificity than ANY logic. A > V branch: ANY logic provided adequate sensitivity. The combination of morphology only in V = A with interval stability or morphology (ANY logic) in V < A, provided the optimal result with sensitivity, specificity, positive, and negative predictive values of 99%, 79%, 87%, and 98%, respectively. Conclusion: SVT-VT combined discriminators strongly influence dual-chamber SVT-VT discrimination performance. In our study, optimal programming is morphology only in the V = A branch and morphology or interval stability (ANY) in the V < A branch. ALL logic should be used with caution due to loss of sensitivity.

Original languageEnglish (US)
Pages (from-to)732-739
Number of pages8
JournalJournal of Cardiovascular Electrophysiology
Volume16
Issue number7
DOIs
StatePublished - Jul 2005

Fingerprint

Supraventricular Tachycardia
Defibrillators
Ventricular Tachycardia
Implantable Defibrillators
Tachycardia
Photons
Cardiac Arrhythmias
Sensitivity and Specificity

Keywords

  • Detection algorithm
  • Detection enhancement
  • Detection ventricular tachycardia
  • Discrimination algorithm
  • Implantable cardioverter defibrillator
  • Inappropriate shocks
  • Supraventricular tachycardia

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology

Cite this

Optimal combination of discriminators for differentiating ventricular from supraventricular tachycardia by dual-chamber defibrillators. / Glikson, Michael; Swerdlow, Charles D.; Gurevitz, Osnat T.; Daoud, Emile; Shivkumar, Kalyanam; Wilkoff, Bruce; Shipman, Tamara; Friedman, Paul Andrew.

In: Journal of Cardiovascular Electrophysiology, Vol. 16, No. 7, 07.2005, p. 732-739.

Research output: Contribution to journalArticle

Glikson, Michael ; Swerdlow, Charles D. ; Gurevitz, Osnat T. ; Daoud, Emile ; Shivkumar, Kalyanam ; Wilkoff, Bruce ; Shipman, Tamara ; Friedman, Paul Andrew. / Optimal combination of discriminators for differentiating ventricular from supraventricular tachycardia by dual-chamber defibrillators. In: Journal of Cardiovascular Electrophysiology. 2005 ; Vol. 16, No. 7. pp. 732-739.
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abstract = "Discriminators for Ventricular/Supraventricular Tachycardia. Introduction: Dual-chamber implantable cardioverter defibrillators (ICDs) use discriminators to differentiate between supraventricular tachycardias (SVTs) and ventricular tachycardias (VT), the accuracy of which may depend on the type and method used. ICDs can combine rate branching of tachyarrhythmias according to their A:V relationship with two SVT-VT discriminators in each rate branch, using ANY (either) or ALL (both) logic. Our goal was to determine the optimal discriminator combination. Methods: Stored electrogram data from 596 spontaneous tachyarrhythmias from 203 patients with Photon DR ICDs were analyzed. Arrhythmias are first classified by the relationship of atrial and ventricular rates (rate branches V < A, V = A, and V > A) followed by additional discriminators: morphology and/or sudden onset if V = A; morphology and/or interval stability if V < A. Data were analyzed for all combinations of ANY and ALL logic. Results: Sensitivity and specificity were calculated for all spontaneous episodes in each analysis. V = A branch: ALL logic produced unacceptably low sensitivity, whereas morphology provided only similar sensitivity but better specificity than ANY logic. A > V branch: ANY logic provided adequate sensitivity. The combination of morphology only in V = A with interval stability or morphology (ANY logic) in V < A, provided the optimal result with sensitivity, specificity, positive, and negative predictive values of 99{\%}, 79{\%}, 87{\%}, and 98{\%}, respectively. Conclusion: SVT-VT combined discriminators strongly influence dual-chamber SVT-VT discrimination performance. In our study, optimal programming is morphology only in the V = A branch and morphology or interval stability (ANY) in the V < A branch. ALL logic should be used with caution due to loss of sensitivity.",
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T1 - Optimal combination of discriminators for differentiating ventricular from supraventricular tachycardia by dual-chamber defibrillators

AU - Glikson, Michael

AU - Swerdlow, Charles D.

AU - Gurevitz, Osnat T.

AU - Daoud, Emile

AU - Shivkumar, Kalyanam

AU - Wilkoff, Bruce

AU - Shipman, Tamara

AU - Friedman, Paul Andrew

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AB - Discriminators for Ventricular/Supraventricular Tachycardia. Introduction: Dual-chamber implantable cardioverter defibrillators (ICDs) use discriminators to differentiate between supraventricular tachycardias (SVTs) and ventricular tachycardias (VT), the accuracy of which may depend on the type and method used. ICDs can combine rate branching of tachyarrhythmias according to their A:V relationship with two SVT-VT discriminators in each rate branch, using ANY (either) or ALL (both) logic. Our goal was to determine the optimal discriminator combination. Methods: Stored electrogram data from 596 spontaneous tachyarrhythmias from 203 patients with Photon DR ICDs were analyzed. Arrhythmias are first classified by the relationship of atrial and ventricular rates (rate branches V < A, V = A, and V > A) followed by additional discriminators: morphology and/or sudden onset if V = A; morphology and/or interval stability if V < A. Data were analyzed for all combinations of ANY and ALL logic. Results: Sensitivity and specificity were calculated for all spontaneous episodes in each analysis. V = A branch: ALL logic produced unacceptably low sensitivity, whereas morphology provided only similar sensitivity but better specificity than ANY logic. A > V branch: ANY logic provided adequate sensitivity. The combination of morphology only in V = A with interval stability or morphology (ANY logic) in V < A, provided the optimal result with sensitivity, specificity, positive, and negative predictive values of 99%, 79%, 87%, and 98%, respectively. Conclusion: SVT-VT combined discriminators strongly influence dual-chamber SVT-VT discrimination performance. In our study, optimal programming is morphology only in the V = A branch and morphology or interval stability (ANY) in the V < A branch. ALL logic should be used with caution due to loss of sensitivity.

KW - Detection algorithm

KW - Detection enhancement

KW - Detection ventricular tachycardia

KW - Discrimination algorithm

KW - Implantable cardioverter defibrillator

KW - Inappropriate shocks

KW - Supraventricular tachycardia

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