New ICD morphology criterion for differentiation of supraventricular and ventricular tachycardia

The high incidence of inappropriate therapies due to supraventricular tachycardia remains a major unsolved problem of the implantable cardioverter defibrillator. A new morphology discrimination (MD) algorithm has been introduced to improve specificity of ICD therapy without loss of sensitivity. It was the aim of this study to systematically analyze sensitivity and specificity of the MD criterion in combination with the enhanced detection criteria sudden onset and rate stability in the detection of ventricular and supraventricular tachycardia. After ICD implantation in 259 patients, 787 detected episodes in 74 patients with available stored electrograms were documented during a follow-up period of 359+/-214 days. With a nominal programming of the MD algorithm at >60%, sensitivity and specificity for all episodes were 82.6%/77.2%. For sinus tachycardia, atrial fibrillation and atrial flutter the specificities were 80.6%, 69.6% and 75%, respectively. In patients with primarily appropriate MD detection, sensitivity and specificity significantly improved to 95.8%/91.7%. Programming the sudden onset criterion with <100 ms and the stability criterion with <50 ms, sensitivity and stability of the combined application of the MD algorithm and sudden onset and MD algorithm and stability were 96.2%/52.2% and 94.4%/ 63.8%, respectively. The MD criterion in combination with other enhanced detection criteria might significantly improve specificity of tachyarryhthmia detection of ICD therapy.