title: Reduction of the inappropriate ICD therapies by implementing a new fuzzy logic-based diagnostic algorithm.
abstract: OBJECTIVE
  The aim of the study was to analyze the value of a completely new fuzzy logic-based detection algorithm (FA) in comparison with arrhythmia classification algorithms used in existing ICDs in order to demonstrate whether the rate of inappropriate therapies can be reduced.
  
  
  METHODS
  On the basis of the RR intervals database containing arrhythmia events and controls recordings from the ICD memory a diagnostic algorithm was developed and tested by a computer program. This algorithm uses the same input signals as existing ICDs: RR interval as the primary input variable and two variables derived from it, onset and stability. However, it uses 15 fuzzy rules instead of fixed thresholds used in existing devices. The algorithm considers 6 diagnostic categories: (1) VF (ventricular fibrillation), (2) VT (ventricular tachycardia), (3) ST (sinus tachycardia), (4) DAI (artifacts and heart rhythm irregularities including extrasystoles and T-wave oversensing-TWOS), (5) ATF (atrial and supraventricular tachycardia or fibrillation), and 96) NT (sinus rhythm). This algorithm was tested on 172 RR recordings from different ICDs in the follow-up of 135 patients.
  
  
  RESULTS
  All diagnostic categories of the algorithm were present in the analyzed recordings: VF (n = 35), VT (n = 48), ST (n = 14), DAI (n = 32), ATF (n = 18), NT (n = 25). Thirty-eight patients (31.4%) in the studied group received inappropriate ICD therapies. In all these cases the final diagnosis of the algorithm was correct (19 cases of artifacts, 11 of atrial fibrillation and 8 of ST) and fuzzy rules algorithm implementation would have withheld unnecessary therapies. Incidence of inappropriate therapies: 3 vs. 38 (the proposed algorithm vs. ICD diagnosis, respectively) differed significantly (p < 0.05). VT/VF were detected correctly in both groups. Sensitivity and specificity were calculated: 100%, 97.8%, and 100%, 72.9% respectively for FA and tested ICDs recordings (p < 0.05).
  
  
  CONCLUSIONS
  Diagnostic performance of the proposed fuzzy logic based algorithm seems to be promising and its implementation could diminish ICDs inappropriate therapies. We found FA usefulness in correct diagnosis of sinus tachycardia, atrial fibrillation and artifacts in comparison with tested ICDs.
authors.affiliation: II Coronary Disease Department, Institute of Cardiology, Warsaw, Poland.
authors.forename: Michał
authors.initials: M
authors.lastname: Lewandowski
authors.forename: Andrzej
authors.initials: A
authors.lastname: Przybylski
authors.forename: Wiesław
authors.initials: W
authors.lastname: Kuźmicz
authors.forename: Hanna
authors.initials: H
authors.lastname: Szwed
mesh_terms: D000465:Algorithms; D001145:Arrhythmias, Cardiac / Q000175:diagnosis* / Q000628:therapy*; D017147:Defibrillators, Implantable; D003936:Diagnosis, Computer-Assisted / Q000379:methods*; D003937:Diagnosis, Differential; D005260:Female; D005500:Follow-Up Studies; D017143:Fuzzy Logic; D006801:Humans; D008297:Male; D008875:Middle Aged; D012680:Sensitivity and Specificity
keywords: fuzzy logic; implantable cardioverter-defibrillator(ICD); inappropriate ICD therapies; supraventricular versus ventricular tachycardia discrimination algorithms
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