title: The value of rate regularity and multiplicity measures to detect ventricular tachycardia in the presence of atrial fibrillation or flutter.
abstract: The predominant cause of inappropriate therapy by implantable antitachycardia devices with pacing and nonpacing cardioverter defibrillators, is mistaking a fast ventricular response during atrial fibrillation or flutter with true ventricular tachycardia (VT). The distinction between these arrhythmias is an important consideration in addressing the problem of reducing false-positives in detection mechanisms for implantable devices. Dual chamber analysis that examines atrial and ventricular event ratios has been proposed as a solution to this problem, but would still fail in distinguishing paroxysmal VT requiring treatment from a fast but otherwise benign ventricular response during atrial fibrillation or flutter. In this study, two methods for discriminating these tachyarrhythmias were evaluated. Method 1 examined ventricular rate and rate regularity as a method for VT detection. Method 2 combined rate and regularity as well as an additional multiplicity criterion for recognition of atrial flutter with a fast ventricular response. In 20 patients, Method 1 had 100% sensitivity of VT detection and 80% specificity for detection of atrial fibrillation or flutter. Method 2 had 90% sensitivity and 90% specificity. These results suggest that use of these algorithms in future implantable devices would result in a decrease in false-positive device therapies.
authors.affiliation: Department of Electrical Engineering, University of Michigan.
authors.forename: C M
authors.initials: CM
authors.lastname: Chiang
authors.forename: J M
authors.initials: JM
authors.lastname: Jenkins
authors.forename: L A
authors.initials: LA
authors.lastname: DiCarlo
mesh_terms: D000465:Algorithms; D001281:Atrial Fibrillation / Q000503:physiopathology*; D001282:Atrial Flutter / Q000503:physiopathology*; D016275:Atrial Function / Q000502:physiology; D003663:Decision Trees; D017147:Defibrillators, Implantable; D004867:Equipment Design; D004868:Equipment Failure; D005189:False Positive Reactions; D006339:Heart Rate / Q000502:physiology*; D006801:Humans; D010138:Pacemaker, Artificial; D010363:Pattern Recognition, Automated; D012680:Sensitivity and Specificity; D012815:Signal Processing, Computer-Assisted; D013614:Tachycardia, Paroxysmal / Q000503:physiopathology / Q000628:therapy; D017180:Tachycardia, Ventricular / Q000503:physiopathology* / Q000628:therapy*; D016276:Ventricular Function / Q000502:physiology