title: Tachycardia detection in modern implantable cardioverter-defibrillators.
abstract: Implantable cardioverter-defibrillators (ICD) have to reliably sense, detect, and treat malignant ventricular tachyarrhythmias. Inappropriate treatment of non life-threatening tachyarrhythmias should be avoided. This article outlines the functionality of ICDs developed and manufactured by BIOTRONIK. Proper sensing is achieved by an automatic sensitivity control which can be individually tailored to solve special under- and oversensing situations. The programming of detection zones for ventricular fibrillation (VF), ventricular tachycardia (VT), and zones to monitor other tachyarrhythmias is outlined. Dedicated single-chamber detection algorithms based on average heart rate, cycle length variability, sudden rate onset, and changes in QRS morphology as used in ICDs by BIOTRONIK are described in detail. Preconditions and confirmation algorithms for therapy deliveries as antitachycardia pacing (ATP) and high energy shocks are explained. Finally, a detailed description of the dual-chamber detection algorithm SMART is given. It comprises additional detection criteria as stability of atrial intervals, 1:1 conduction, atrial-ventricular (AV) multiplicity, AV trend, and AV regularity to differentiate between ventricular and supraventricular tachyarrhythmias.
authors: Global Education and Training, Cardiac Rhythm Management, BIOTRONIK SE & Co. KG, Woermannkehre 1, 12349, Berlin, Germany. thomas.brueggemann@biotronik.com.
authors: Thomas
authors: T
authors: Brüggemann
authors: Technical Services, BIOTRONIK Inc., Lake Oswigo, OR, USA.
authors: Daniel
authors: D
authors: Dahlke
authors: Global Education and Training, Cardiac Rhythm Management, BIOTRONIK SE & Co. KG, Woermannkehre 1, 12349, Berlin, Germany.
authors: Amin
authors: A
authors: Chebbo
authors: Global Education and Training, Cardiac Rhythm Management, BIOTRONIK SE & Co. KG, Woermannkehre 1, 12349, Berlin, Germany.
authors: Ilka
authors: I
authors: Neumann
mesh_terms: D000465:Algorithms; D017147:Defibrillators, Implantable / Q000639:trends*; D003936:Diagnosis, Computer-Assisted / Q000639:trends; D004562:Electrocardiography / Q000295:instrumentation / Q000639:trends; D019317:Evidence-Based Medicine; D005858:Germany; D006801:Humans; D017180:Tachycardia, Ventricular / Q000175:diagnosis* / Q000628:therapy*; D013813:Therapy, Computer-Assisted / Q000639:trends*; D016896:Treatment Outcome; D014693:Ventricular Fibrillation / Q000175:diagnosis* / Q000628:therapy*
keywords: BIOTRONIK; Dual-chamber detection; Implantable cardioverter defibrillator; Single-chamber detection; Tachycardia discrimination; Ventricular fibrillation; Ventricular tachycardia