Morphology discrimination criterion wavelet improves rhythm discrimination in single-chamber implantable cardioverter-defibrillators: Spanish Register of morphology discrimination criterion wavelet (REMEDIO)

Toquero, Jorge; Alzueta, Javier; Mont, Lluı́s; Lozano, Ignacio Fernández; Barrera, Alberto; Berruezo, Antonio; Castro, Victor; Peña, José Luis; Fidalgo, María Luisa; Brugada, Josep

doi:10.1093/europace/eup099

Cited by 26 publications

(17 citation statements)

References 16 publications

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“…It is important to point out that VT episodes classified as SVT, where the lower sensitivity was identified, had a cycle length of Ͼ320 ms and never led to significant clinical consequences. 28 In summary, MD is the single most effective SVT/VT discrimination enhancement in ICDs, especially in SC ICDs.…”

Section: Detection Of Svtmentioning

confidence: 94%

Minimizing Inappropriate or “Unnecessary” Implantable Cardioverter-Defibrillator Shocks

Koneru

Swerdlow

Wood

et al. 2011

Circ: Arrhythmia and Electrophysiology

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L ife-saving shocks are the raisons d'être of implantable cardioverter-defibrillators (ICDs). Paradoxically, shocks also cause much of the morbidity associated with ICDs. Consistently, shocks reduce quality of life, 1,2 and rarely, they may cause proarrhythmia. 3,4 Additionally, shocks have been reported to be associated with excess mortality. 5 Experts disagree about whether shocks are responsible for this excess mortality, 6 but they do agree that ICDs should deliver the fewest shocks necessary to protect patients from ventricular tachycardia (VT) or ventricular fibrillation (VF).Minimizing ICD shocks requires a comprehensive approach, beginning with patient selection, 7 general medical care (eg, preventing electrolyte abnormalities), and general cardiac care (preventing ischemia and treating heart failure). It includes the use of antiarrhythmic drugs and catheter ablation both to prevent VT or supraventricular tachycardia (SVT) and to control the ventricular rate in atrial fibrillation (AF) as well as the appropriate choice of hardware and device programming. This review focuses on ICD features and programming to minimize shocks. OverviewFigure 1 summarizes the sequential processes required for an ICD to deliver a shock. The sense amplifiers convert the continuous electrogram (EGM) from the tip of the right ventricular (RV) lead into a series of instantaneously sensed events representing ventricular depolarization. This series of sensed events is processed by ICD algorithms, including those for initial detection; SVT-VT discrimination; and in some models of ICDs, enhancements to minimize oversensing. If the rhythm is classified as a VT, antitachycardia pacing (ATP) can be delivered. The ICD then performs a redetection process, which results in determination that the devicedefined VT either has terminated or persists. If VT is redetected, the process iterates until all programmed ATPs are delivered. The ICD then charges the high-voltage capacitors, during which time a final round of ATP may be delivered. After capacitor charging, the ICD confirms that VT/VF is present before delivering a shock. Each step provides opportunities to minimize unnecessary shocks. Although Figure 1 shows the ICD process, we consider features and programming in the approximate order that most electrophysiologists program ICDs: (1) rate and duration for initial detection, (2) SVT-VT discrimination, (3) ATP and shock strength, (4) redetection/confirmation, and (5) sensing enhancements.Historically, shocks were classified as appropriate if delivered during VT/VF and inappropriate if delivered during other rhythms. However, some shocks delivered during VT may be avoided by programming ATP or permitting nonsustained VT to spontaneously terminate. In this review, we classify shocks as either necessary to ensure patient safety or unnecessary. Necessary shocks are those that terminate ventricular tachyarrhythmias that would not spontaneously terminate or cannot be terminated by ATP. Unnecessary shocks include those that have been traditional...

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Section: Detection Of Svtmentioning

confidence: 94%

Minimizing Inappropriate or “Unnecessary” Implantable Cardioverter-Defibrillator Shocks

Koneru

Swerdlow

Wood

et al. 2011

Circ: Arrhythmia and Electrophysiology

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show abstract

“…Onset carries an increased risk of misdiagnosing VT since it scrutinises the tachycardia only once at initiation, unlike stability that constantly reanalyses the rhythm. Morphology may be programmed alone with data suggesting specificity for SVT > 90% [58]; however, sensitivity for VT may be as low as 90.6% [59]. In dual-chamber Medtronic devices we suggest programming PR Logic as the sole discriminator, validated in the DATAS trial [60] described below.…”

Section: Svt Discriminatorsmentioning

confidence: 99%

Recommendations for the Programming of Implantable Cardioverter-Defibrillators in New Zealand

Webber

Stiles

2012

Heart, Lung and Circulation

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“…However, rate-related aberrancy during rapidly conducted atrial fibrillation is likely to be misclassified. As we stated in a recent publication (Toquero et al, 2009), probably morphology algorithms as an SVT discrimination criteria should be considered as an effective tool when used alone but, in order to maximize the benefits, a lower limit of 500 ms and the concomitant use of other discrimination criteria or combination with a high rate time-out feature should be considered. When programming several discriminators together, the more we use the better the specificity for SVT but carries a greater risk of underdetecting VT, so once again we have to individualize and tailor the programming to each patient.…”

Section: Morphology Algorithmsmentioning

confidence: 99%

New Ways to Avoid Unnecessary and Inappropriate Shocks

Toquero¹,

Castro²,

Mitroi³

et al. 2011

Cardiac Defibrillation - Mechanisms, Challenges and Implications

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Morphology discrimination criterion wavelet improves rhythm discrimination in single-chamber implantable cardioverter-defibrillators: Spanish Register of morphology discrimination criterion wavelet (REMEDIO)

Cited by 26 publications

References 16 publications

Minimizing Inappropriate or “Unnecessary” Implantable Cardioverter-Defibrillator Shocks

Minimizing Inappropriate or “Unnecessary” Implantable Cardioverter-Defibrillator Shocks

Recommendations for the Programming of Implantable Cardioverter-Defibrillators in New Zealand

New Ways to Avoid Unnecessary and Inappropriate Shocks

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