Clinical Comparison of ICD Detection Algorithms that Include Rapid-VT Zones
Introduction: The safe use of antitachycardia pacing (ATP) to terminate rapid ventricular tachycardias (VTs) (cycle length 240–320 ms) is predicated on the ability of implantable cardioverter defibrillators (ICDs) to distinguish rapid VT from ventricular fibrillation (VF). We set out to compare the...
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| Published in | Pacing and clinical electrophysiology Vol. 35; no. 10; pp. 1222 - 1231 |
|---|---|
| Main Authors | , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
Malden, USA
Blackwell Publishing Inc
01.10.2012
Wiley |
| Subjects | |
| Online Access | Get full text |
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| Abstract | Introduction: The safe use of antitachycardia pacing (ATP) to terminate rapid ventricular tachycardias (VTs) (cycle length 240–320 ms) is predicated on the ability of implantable cardioverter defibrillators (ICDs) to distinguish rapid VT from ventricular fibrillation (VF). We set out to compare the time to device charging following the induction of VF of various ICD multizone detection algorithms for rapid VT/VF discrimination.
Methods and Results: Data on the time to device charging following the induction of VF at the time to device implantation were collected on 62 consecutive patients in a nonrandomized prospective cohort fashion. Multizone programming for the Boston Scientific, Medtronic, and St. Jude Medical devices was based on prior clinically validated data. Sixty‐two subjects were studied (Boston Scientific = 16, Medtronic = 27, St. Jude Medical = 19) and 124 tests for VF detection were performed (Boston Scientific = 32, Medtronic = 54, St. Jude Medical = 38). Mean time to charging was significantly prolonged in the Boston Scientific group as was the percentage of tests where charge initiation occurred >5 seconds from VF‐induction: 4.24, 3.99, and 3.00 seconds and 19%, 4%, and 0% for the Boston Scientific, Medtronic, and St. Jude Medical groups, respectively, P < 0.05. ATP was the first therapy administered in 9.4% of tests in the Boston Scientific group.
Conclusion: The Boston Scientific multizone VT/VF discrimination algorithm results in a prolonged time to VF detection, and consequently, prolonged time to appropriate initiation of device charging. Further studies are needed to determine whether prolonged detection times lead to clinically significant events. (PACE 2012; 35:1222–1231) |
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| AbstractList | The safe use of antitachycardia pacing (ATP) to terminate rapid ventricular tachycardias (VTs) (cycle length 240-320 ms) is predicated on the ability of implantable cardioverter defibrillators (ICDs) to distinguish rapid VT from ventricular fibrillation (VF). We set out to compare the time to device charging following the induction of VF of various ICD multizone detection algorithms for rapid VT/VF discrimination.INTRODUCTIONThe safe use of antitachycardia pacing (ATP) to terminate rapid ventricular tachycardias (VTs) (cycle length 240-320 ms) is predicated on the ability of implantable cardioverter defibrillators (ICDs) to distinguish rapid VT from ventricular fibrillation (VF). We set out to compare the time to device charging following the induction of VF of various ICD multizone detection algorithms for rapid VT/VF discrimination.Data on the time to device charging following the induction of VF at the time to device implantation were collected on 62 consecutive patients in a nonrandomized prospective cohort fashion. Multizone programming for the Boston Scientific, Medtronic, and St. Jude Medical devices was based on prior clinically validated data. Sixty-two subjects were studied (Boston Scientific = 16, Medtronic = 27, St. Jude Medical = 19) and 124 tests for VF detection were performed (Boston Scientific = 32, Medtronic = 54, St. Jude Medical = 38). Mean time to charging was significantly prolonged in the Boston Scientific group as was the percentage of tests where charge initiation occurred >5 seconds from VF-induction: 4.24, 3.99, and 3.00 seconds and 19%, 4%, and 0% for the Boston Scientific, Medtronic, and St. Jude Medical groups, respectively, P < 0.05. ATP was the first therapy administered in 9.4% of tests in the Boston Scientific group.METHODS AND RESULTSData on the time to device charging following the induction of VF at the time to device implantation were collected on 62 consecutive patients in a nonrandomized prospective cohort fashion. Multizone programming for the Boston Scientific, Medtronic, and St. Jude Medical devices was based on prior clinically validated data. Sixty-two subjects were studied (Boston Scientific = 16, Medtronic = 27, St. Jude Medical = 19) and 124 tests for VF detection were performed (Boston Scientific = 32, Medtronic = 54, St. Jude Medical = 38). Mean time to charging was significantly prolonged in the Boston Scientific group as was the percentage of tests where charge initiation occurred >5 seconds from VF-induction: 4.24, 3.99, and 3.00 seconds and 19%, 4%, and 0% for the Boston Scientific, Medtronic, and St. Jude Medical groups, respectively, P < 0.05. ATP was the first therapy administered in 9.4% of tests in the Boston Scientific group.The Boston Scientific multizone VT/VF discrimination algorithm results in a prolonged time to VF detection, and consequently, prolonged time to appropriate initiation of device charging. Further studies are needed to determine whether prolonged detection times lead to clinically significant events.CONCLUSIONThe Boston Scientific multizone VT/VF discrimination algorithm results in a prolonged time to VF detection, and consequently, prolonged time to appropriate initiation of device charging. Further studies are needed to determine whether prolonged detection times lead to clinically significant events. Introduction: The safe use of antitachycardia pacing (ATP) to terminate rapid ventricular tachycardias (VTs) (cycle length 240–320 ms) is predicated on the ability of implantable cardioverter defibrillators (ICDs) to distinguish rapid VT from ventricular fibrillation (VF). We set out to compare the time to device charging following the induction of VF of various ICD multizone detection algorithms for rapid VT/VF discrimination. Methods and Results: Data on the time to device charging following the induction of VF at the time to device implantation were collected on 62 consecutive patients in a nonrandomized prospective cohort fashion. Multizone programming for the Boston Scientific, Medtronic, and St. Jude Medical devices was based on prior clinically validated data. Sixty‐two subjects were studied (Boston Scientific = 16, Medtronic = 27, St. Jude Medical = 19) and 124 tests for VF detection were performed (Boston Scientific = 32, Medtronic = 54, St. Jude Medical = 38). Mean time to charging was significantly prolonged in the Boston Scientific group as was the percentage of tests where charge initiation occurred >5 seconds from VF‐induction: 4.24, 3.99, and 3.00 seconds and 19%, 4%, and 0% for the Boston Scientific, Medtronic, and St. Jude Medical groups, respectively, P < 0.05. ATP was the first therapy administered in 9.4% of tests in the Boston Scientific group. Conclusion: The Boston Scientific multizone VT/VF discrimination algorithm results in a prolonged time to VF detection, and consequently, prolonged time to appropriate initiation of device charging. Further studies are needed to determine whether prolonged detection times lead to clinically significant events. (PACE 2012; 35:1222–1231) The safe use of antitachycardia pacing (ATP) to terminate rapid ventricular tachycardias (VTs) (cycle length 240-320 ms) is predicated on the ability of implantable cardioverter defibrillators (ICDs) to distinguish rapid VT from ventricular fibrillation (VF). We set out to compare the time to device charging following the induction of VF of various ICD multizone detection algorithms for rapid VT/VF discrimination. Data on the time to device charging following the induction of VF at the time to device implantation were collected on 62 consecutive patients in a nonrandomized prospective cohort fashion. Multizone programming for the Boston Scientific, Medtronic, and St. Jude Medical devices was based on prior clinically validated data. Sixty-two subjects were studied (Boston Scientific = 16, Medtronic = 27, St. Jude Medical = 19) and 124 tests for VF detection were performed (Boston Scientific = 32, Medtronic = 54, St. Jude Medical = 38). Mean time to charging was significantly prolonged in the Boston Scientific group as was the percentage of tests where charge initiation occurred >5 seconds from VF-induction: 4.24, 3.99, and 3.00 seconds and 19%, 4%, and 0% for the Boston Scientific, Medtronic, and St. Jude Medical groups, respectively, P < 0.05. ATP was the first therapy administered in 9.4% of tests in the Boston Scientific group. The Boston Scientific multizone VT/VF discrimination algorithm results in a prolonged time to VF detection, and consequently, prolonged time to appropriate initiation of device charging. Further studies are needed to determine whether prolonged detection times lead to clinically significant events. Introduction: The safe use of antitachycardia pacing (ATP) to terminate rapid ventricular tachycardias (VTs) (cycle length 240–320 ms) is predicated on the ability of implantable cardioverter defibrillators (ICDs) to distinguish rapid VT from ventricular fibrillation (VF). We set out to compare the time to device charging following the induction of VF of various ICD multizone detection algorithms for rapid VT/VF discrimination. Methods and Results: Data on the time to device charging following the induction of VF at the time to device implantation were collected on 62 consecutive patients in a nonrandomized prospective cohort fashion. Multizone programming for the Boston Scientific, Medtronic, and St. Jude Medical devices was based on prior clinically validated data. Sixty‐two subjects were studied (Boston Scientific = 16, Medtronic = 27, St. Jude Medical = 19) and 124 tests for VF detection were performed (Boston Scientific = 32, Medtronic = 54, St. Jude Medical = 38). Mean time to charging was significantly prolonged in the Boston Scientific group as was the percentage of tests where charge initiation occurred >5 seconds from VF‐induction: 4.24, 3.99, and 3.00 seconds and 19%, 4%, and 0% for the Boston Scientific, Medtronic, and St. Jude Medical groups, respectively, P < 0.05. ATP was the first therapy administered in 9.4% of tests in the Boston Scientific group. Conclusion: The Boston Scientific multizone VT/VF discrimination algorithm results in a prolonged time to VF detection, and consequently, prolonged time to appropriate initiation of device charging. Further studies are needed to determine whether prolonged detection times lead to clinically significant events. (PACE 2012; 35:1222–1231) |
| Author | CHINITZ, LARRY A. AIZER, ANTHONY RAO, SATYA BERNSTEIN, NEIL E. HOLMES, DOUGLAS S. HIRSH, DAVID S. |
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| Keywords | Heart failure Arrhythmia Implantable cardioverter defibrillator Electrophysiology Instrumentation therapy Cardiovascular disease Ventricular tachycardia Algorithm Excitability disorder Ventricular fibrillation Instrumental stimulation Heart disease electrophysiology—clinical congestive heart failure Diagnosis Comparative study |
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| References | PCD Investigator Group. Clinical outcome of patients with malignant ventricular tachyarrhythmias and a multiprogrammable implantable cardioverter-defibrillator implanted with or without thoracotomy: An international multicenter study. J Am Coll Cardiol 1994; 23:1521-1530. Schaumann A, von zur Muhlen F, Herse B, Gonska BD, Kreuzer H. Empirical versus tested antitachycardia pacing in implantable cardioverter defibrillators: A prospective study including 200 patients. Circulation 1998; 97:66-74. Wood MA, Stambler BS, Damiano RJ, Greenway P, Ellenbogen KA. Lessons learned from data logging in a multicenter clinical trial using a late-generation implantable cardioverter-defibrillator. The Guardian ATP 4210 Multicenter Investigators Group. J Am Coll Cardiol 1994; 24:1692-1699. Li H, Easley A, Windle J, Samoil D, Barrington W. The mean ventricular fibrillation cycle length: A potentially useful parameter for programming implantable cardioverter defibrillators. Pacing Clin Electrophysiol 1998; 21:1789-1794. Moss AJ, Zareba W, Hall WJ, Wilber DJ, Cannom DS, Daubert JP, Higgins SL, et al. Prophylactic implantation of a defibrillator in patients with myocardial infarction and reduced ejection fraction. N Engl J Med 2002; 346:877-883. Lever NA, Newall EG, Larsen PD. Differences in the characteristics of induced and spontaneous episodes of ventricular fibrillation. Europace 2008; 9:1054-1058. Saeed M, Swygman C, Mark Estes III NA. Comparative features, functions and longevities of implantable cardioverter defibrillators. Cardiac Electrophys Rev 2001; 5:41-46. Farmer DM, Swygman CA, Wang PJ, Estes NA III, Link MS. Evidence that non-sustained polymorphic ventricular tachycardia causes syncope (data from implantable cardioverter defibrillators). Am J Cardiol 2003; 91:606-609. Nasir N Jr., Pacifico A, Doyle TK, Earle NR, Hardage ML, Henry PD. Spontaneous ventricular tachycardia treated by antitachycardia pacing. Cadence Investigators. Am J Cardiol 1997; 79:820-822. The Antiarrhythmics Versus Implantable Defibrillators (AVID) Investigators. A comparison of antiarrhythmic-drug therapy with implantable defibrillators in patients resuscitated from near-fatal ventricular arrhythmias. N Engl J Med 1997; 337:1576-1583. Windecker S, Ideker RE, Plumb VJ, Kay GN, Walcott GP, Epstein AE. The influence of ventricular fibrillation duration on defibrillation efficacy using biphasic waveforms in humans. J Am Coll Cardiol 1999; 33:33-38. Moss, AJ, Hall WJ, Cannom DS, Daubert JP, Higgins SL, Klein H, Levine JH, et al. Improved survival with an implanted defibrillator in patients in patients with coronary disease at high risk for ventricular arrhythmia. N Engl J Med 1996; 335:1933-1940. Wathen MS, DeGroot PJ, Sweeney MO, Stark AJ, Otterness MF, Adkisson WO, Canby RC, et al.; PainFREE Rx II Investigators. Prospective randomized multicenter trial of empirical antitachycardia pacing versus shocks for spontaneous rapid ventricular tachycardia in patients with implantable cardioverter-defibrillators: Pacing Fast Ventricular Tachycardia Reduces Shock Therapies (PainFREE Rx II) trial results. Circulation 2004; 110:2591-2596. Misier AR, Opthof T, van Hemel NM, Vermeulen JT, de Bakker JM, Defauw JJ, van Capelle FJ, et al. Dispersion of refractoriness in noninfarcted myocardium of patients with ventricular tachycardia or ventricular fibrillation after myocardial infarction. Circulation 1995; 91:2566-2572. Bardy GH, Lee KL, Mark DB, Poole JE, Packer DL, Boineau R, Domanski M, et al. Amiodarone or an implantable cardioverter-defibrillator for congestive heart failure. N Engl J Med 2005; 352:225-237. Nunain SO, Roelke M, Trouton T, Osswald S, Kim YH, Sosa-Suarez G, Brooks DR, et al. Limitations and late complications of third-generation automatic cardioverter-defibrillators. Circulation 1995; 91:2204-2213. Fenelon G, Stambler BS, Huvelle E, Brugada P, Stevenson WG; European VENTAK MINI Investigator Group. Left ventricular dysfunction is associated with prolonged average ventricular fibrillation cycle length in patients with implantable cardioverter defibrillators. J Interv Card Electrophysiol 2002; 7:249-254. 2004; 110 1997; 337 2003; 91 1995; 91 2005; 352 2001; 5 1997; 79 2002; 7 1994; 23 2008; 9 2002; 346 1999; 33 1994; 24 1996; 335 1998; 21 1998; 97 Moss AJ (e_1_2_9_3_2) 2002; 346 Wathen MS (e_1_2_9_6_2) 2004; 110 e_1_2_9_10_2 Schaumann A (e_1_2_9_13_2) 1998; 97 e_1_2_9_11_2 e_1_2_9_7_2 Nunain SO (e_1_2_9_12_2) 1995; 91 Moss AJ (e_1_2_9_2_2) 1996; 335 Lever NA (e_1_2_9_18_2) 2008; 9 Bardy GH (e_1_2_9_4_2) 2005; 352 Saeed M (e_1_2_9_14_2) 2001; 5 e_1_2_9_8_2 The Antiarrhythmics Versus Implantable Defibrillators (AVID) Investigators (e_1_2_9_5_2) 1997; 337 e_1_2_9_16_2 e_1_2_9_15_2 PCD Investigator Group (e_1_2_9_9_2) 1994; 23 e_1_2_9_17_2 |
| References_xml | – reference: Bardy GH, Lee KL, Mark DB, Poole JE, Packer DL, Boineau R, Domanski M, et al. Amiodarone or an implantable cardioverter-defibrillator for congestive heart failure. N Engl J Med 2005; 352:225-237. – reference: Farmer DM, Swygman CA, Wang PJ, Estes NA III, Link MS. Evidence that non-sustained polymorphic ventricular tachycardia causes syncope (data from implantable cardioverter defibrillators). Am J Cardiol 2003; 91:606-609. – reference: PCD Investigator Group. Clinical outcome of patients with malignant ventricular tachyarrhythmias and a multiprogrammable implantable cardioverter-defibrillator implanted with or without thoracotomy: An international multicenter study. J Am Coll Cardiol 1994; 23:1521-1530. – reference: Wood MA, Stambler BS, Damiano RJ, Greenway P, Ellenbogen KA. Lessons learned from data logging in a multicenter clinical trial using a late-generation implantable cardioverter-defibrillator. The Guardian ATP 4210 Multicenter Investigators Group. J Am Coll Cardiol 1994; 24:1692-1699. – reference: Li H, Easley A, Windle J, Samoil D, Barrington W. The mean ventricular fibrillation cycle length: A potentially useful parameter for programming implantable cardioverter defibrillators. Pacing Clin Electrophysiol 1998; 21:1789-1794. – reference: Windecker S, Ideker RE, Plumb VJ, Kay GN, Walcott GP, Epstein AE. The influence of ventricular fibrillation duration on defibrillation efficacy using biphasic waveforms in humans. J Am Coll Cardiol 1999; 33:33-38. – reference: Wathen MS, DeGroot PJ, Sweeney MO, Stark AJ, Otterness MF, Adkisson WO, Canby RC, et al.; PainFREE Rx II Investigators. Prospective randomized multicenter trial of empirical antitachycardia pacing versus shocks for spontaneous rapid ventricular tachycardia in patients with implantable cardioverter-defibrillators: Pacing Fast Ventricular Tachycardia Reduces Shock Therapies (PainFREE Rx II) trial results. Circulation 2004; 110:2591-2596. – reference: The Antiarrhythmics Versus Implantable Defibrillators (AVID) Investigators. A comparison of antiarrhythmic-drug therapy with implantable defibrillators in patients resuscitated from near-fatal ventricular arrhythmias. N Engl J Med 1997; 337:1576-1583. – reference: Fenelon G, Stambler BS, Huvelle E, Brugada P, Stevenson WG; European VENTAK MINI Investigator Group. Left ventricular dysfunction is associated with prolonged average ventricular fibrillation cycle length in patients with implantable cardioverter defibrillators. J Interv Card Electrophysiol 2002; 7:249-254. – reference: Misier AR, Opthof T, van Hemel NM, Vermeulen JT, de Bakker JM, Defauw JJ, van Capelle FJ, et al. Dispersion of refractoriness in noninfarcted myocardium of patients with ventricular tachycardia or ventricular fibrillation after myocardial infarction. Circulation 1995; 91:2566-2572. – reference: Saeed M, Swygman C, Mark Estes III NA. Comparative features, functions and longevities of implantable cardioverter defibrillators. Cardiac Electrophys Rev 2001; 5:41-46. – reference: Nunain SO, Roelke M, Trouton T, Osswald S, Kim YH, Sosa-Suarez G, Brooks DR, et al. Limitations and late complications of third-generation automatic cardioverter-defibrillators. Circulation 1995; 91:2204-2213. – reference: Nasir N Jr., Pacifico A, Doyle TK, Earle NR, Hardage ML, Henry PD. Spontaneous ventricular tachycardia treated by antitachycardia pacing. Cadence Investigators. Am J Cardiol 1997; 79:820-822. – reference: Moss AJ, Zareba W, Hall WJ, Wilber DJ, Cannom DS, Daubert JP, Higgins SL, et al. Prophylactic implantation of a defibrillator in patients with myocardial infarction and reduced ejection fraction. N Engl J Med 2002; 346:877-883. – reference: Moss, AJ, Hall WJ, Cannom DS, Daubert JP, Higgins SL, Klein H, Levine JH, et al. 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article-title: Prospective randomized multicenter trial of empirical antitachycardia pacing versus shocks for spontaneous rapid ventricular tachycardia in patients with implantable cardioverter‐defibrillators: Pacing Fast Ventricular Tachycardia Reduces Shock Therapies (PainFREE Rx II) trial results publication-title: Circulation doi: 10.1161/01.CIR.0000145610.64014.E4 |
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| Snippet | Introduction: The safe use of antitachycardia pacing (ATP) to terminate rapid ventricular tachycardias (VTs) (cycle length 240–320 ms) is predicated on the... Introduction: The safe use of antitachycardia pacing (ATP) to terminate rapid ventricular tachycardias (VTs) (cycle length 240–320 ms) is predicated on the... The safe use of antitachycardia pacing (ATP) to terminate rapid ventricular tachycardias (VTs) (cycle length 240-320 ms) is predicated on the ability of... |
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| SubjectTerms | Aged Aged, 80 and over Algorithms Biological and medical sciences Cardiac dysrhythmias Cardiology. Vascular system congestive heart failure Defibrillators, Implantable Diseases of the cardiovascular system electrophysiology-1231 Female Heart Heart failure, cardiogenic pulmonary edema, cardiac enlargement Humans implantable cardioverter defibrillator Male Medical sciences Middle Aged Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects) Tachycardia, Ventricular - diagnosis Tachycardia, Ventricular - therapy Treatment Outcome ventricular fibrillation Ventricular Fibrillation - diagnosis Ventricular Fibrillation - therapy ventricular tachycardia |
| Title | Clinical Comparison of ICD Detection Algorithms that Include Rapid-VT Zones |
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