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PubMed2000

Long-term clinical experience with the EGM width detection criterion for differentiation of supraventricular and ventricular tachycardia in patients with implantable cardioverter defibrillators.

Inappropriate therapy by ICDs due to SVTs is an important problem. A third generation ICD with a new detection criterion ("EGM width criterion") for differentiation of SVTs and VTs by measuring the width of the intracardiac EGM was studied in 47 patients. A wide EGM was defined as the longest measured EGM plus 4-12 ms (programmed as EGM width threshold). EGM width detection function was programmed to the "Passive" mode so that no therapy was withheld. During a follow-up of 29.9 +/- 8.3 (12-45) months, 489 spontaneous episodes were analyzed. SVTs occurred in ten patients with 305 episodes; 301 were correctly classified by use of the new detection criterion. In four patients four episodes were incorrectly detected as wide QRS tachycardias. Thus specificity for SVT was 98.7% (on a per episode basis) and 60% on a per patient basis. Of 184 VTs in 23 patients, 118 episodes were correctly classified (19 patients), however, in 4 patients 66 VTs were falsely detected as SVTs, 62 (94%) of which occurred in 1 patient with complete left BBB and continuously increasing QRS width in 12-lead surface ECGs. Overall sensitivity (on a per episode basis) for VT detection was 64.1% and 96.7% in patients with stable width of the QRS complex in a 12-lead surface ECG. These data show that this criterion is not superior to data on rate dependent detection criteria and furthermore not applicable in patients with complete BBB.

Adult↗
PubMed2001

Clinical predictors and efficacy of antitachycardia pacing in patients with implantable cardioverter defibrillators: the importance of the patient's sex.

The ICD has become accepted as primary therapy for malignant ventricular arrhythmias. The incorporation of antitachycardia pacing into ICDs has provided a better tolerated alternative to shocks but has the potential disadvantage of delaying definitive therapy. Accordingly, we sought to delineate the characteristics of patients likely to experience unsuccessful termination of pacing and to identify ineffective pacing strategies. Of 519 patients who received ICDs, 11 clinical and tachycardia characteristics in the 162 who received antitachycardia pacing therapy for sustained ventricular arrhythmias were evaluated. Tachycardia episodes were grouped according to outcome of pacing (successful, unsuccessful, acceleration). Of 1,946 episodes, 1,502 (77.2%) were successfully reverted with pacing, 322 (16.5%) were unsuccessful, and 121 (6.2%) were accelerated. Antitachycardia pacing was less successful in women, patients with a history of myocardial infarction, those with more severe left ventricular dysfunction, those who received antiarrhythmic drugs, and those programmed to ramp pacing. Tachycardia acceleration was inversely related to tachycardia cycle length and was more frequent in patients programmed to more aggressive ramp pacing protocols. Women had an almost threefold incidence of tachycardia acceleration compared with men (14% vs 5%, P < 0.001). Antitachycardia pacing is generally successful in terminating ventricular tachycardia and has a low incidence of tachycardia acceleration. Caution should be used with rapid tachycardias and aggressive ramp pacing protocols because of an increased risk of acceleration. Antitachycardia pacing appears less successful and has a higher incidence of complications in women.

Cardiac Pacing, Artificial↗