Supraventricular tachycardia-ventricular tachycardia discrimination algorithms in implantable cardioverter defibrillators: state-of-the-art review.
To reduce inappropriate therapy of supraventricular tachycardia (SVT), implantable cardioverter defibrillators (ICDs) include algorithms to discriminate ventricular tachycardia (VT) from SVT. Dual-chamber algorithms analyze atrial and ventricular rates or AV relationship. They provide advantages over single-chamber algorithms, but introduce new ways to detect SVT as VT inappropriately and to underdetect VT. Unlike pacemakers, dual-chamber ICDs require accurate atrial sensing during high ventricular rates. A postventricular atrial blanking period prevents oversensing of far-field R waves as atrial electrograms, but causes underdetection of atrial fibrillation during high ventricular rates. Tachycardias with 1:1 AV relationship and VT during atrial tachyarrhythmias present specific SVT-VT discrimination problems. The first dual-chamber algorithms performed comparably to single-chamber algorithms. Present dual-chamber algorithms correct some limitations of earlier versions.
Swerdlow
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Division of Cardiology, Cedars-Sinai Medical Center, Los Angeles, California 90048, USA. swerdlow@ucla.edu
D017147:Defibrillators, Implantable / Q000639:trends; D003937:Diagnosis, Differential; D005544:Forecasting; D006801:Humans; D013617:Tachycardia, Supraventricular / Q000175:diagnosis* / Q000628:therapy*; D017180:Tachycardia, Ventricular / Q000175:diagnosis* / Q000628:therapy*; D016387:Women's Health