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CLINICAL RESEARCH: CARDIAC RHYTHM DISTURBANCES

Prevention of inappropriate therapy in implantable cardioverter-defibrillators

Results of a prospective, randomized study of tachyarrhythmia detection algorithms

Dominic A.M.J. Theuns, MSc^*, A. Peter J. Klootwijk, MD, PhD^*, Dick M. Goedhart, MSc and Luc J.L.M. Jordaens, MD, PhD^*,*

^* Department of Cardiology, Thoraxcenter, Erasmus MC, Rotterdam, the Netherlands
Department of Statistics, Cardialysis, Rotterdam, the Netherlands

Manuscript received June 9, 2004; revised manuscript received August 16, 2004, accepted September 4, 2004.

^* Reprint requests and correspondence: Dr. Luc Jordaens, Department of Clinical Electrophysiology, Bd402, Erasmus MC, Dr. Molewaterplein 40, 3015 GD Rotterdam, the Netherlands (Email: l.jordaens{at}erasmusmc.nl).

OBJECTIVES: The purpose of this randomized study was to investigate the performance of single- and dual-chamber tachyarrhythmia detection algorithms.

BACKGROUND: A proposed benefit of dual-chamber implantable cardioverter-defibrillators (ICDs) is improved specificity of tachyarrhythmia detection.

METHODS: All ICD candidates received a dual-chamber ICD and were randomized to programmed single- or dual-chamber detection. Of 60 patients (47 male, age 58 ± 14 years, left ventricular ejection fraction 30%), 29 had single-chamber and 31 had dual-chamber settings. The detection results were corrected for multiple episodes within a patient with the generalized estimating equations method.

RESULTS: A total of 653 spontaneous arrhythmia episodes (39 patients) were classified by the investigators; 391 episodes were ventricular tachyarrhythmia (32 patients). All episodes of ventricular tachyarrhythmias were appropriately detected in both settings. In 25 patients, 262 episodes of atrial tachyarrhythmias were recorded. Detection was inappropriate for 109 atrial tachyarrhythmia episodes (42%, 18 patients). Rejection of atrial tachyarrhythmias was not significantly different between both groups (p = 0.55). Episodes of atrial flutter/tachycardia were significantly more misclassified (p = 0.001). Overall, no significant difference in tachyarrhythmia detection (atrial and ventricular) between both settings was demonstrated (p = 0.77).

CONCLUSIONS: The applied detection criteria in dual-chamber devices do not offer benefits in the rejection of atrial tachyarrhythmias. Discrimination of atrial tachyarrhythmias with a stable atrioventricular relationship remains a challenge.

Abbreviations and Acronyms   AF = atrial fibrillation   AFL = atrial flutter   AT = atrial tachycardia   DC group = dual-chamber supraventricular detection algorithm group   GEE = generalized estimating equation   ICD = implantable cardioverter-defibrillator   SC group = single-chamber supraventricular detection algorithm group   ST = sinus tachycardia

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