Tachyarrhythmia discriminator for implantable cardioverter-defibrillators in bundle branch block

被引:1
作者
Kapoor, Ridhima [1 ]
Tyagi, Sudhi [2 ]
Dohmen, Claire [2 ]
Oujiri, James [2 ]
Roth, James [2 ]
Rubenstein, Jason C. [2 ]
Berger, Marcie [2 ]
机构
[1] Stanford Univ, Dept Med, Sch Med, Stanford, CA 94305 USA
[2] Med Coll Wisconsin, Dept Med, Milwaukee, WI 53226 USA
关键词
Arrhythmia discrimination algorithm; Bundle branch block; Implantable cardioverter-defibrillator; Inappropriate implantable cardioverter defibrillator therapies; Supraventricular tachycardia; Ventricular tachycardia; INAPPROPRIATE; SHOCKS;
D O I
10.1016/j.hrthm.2020.04.031
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
BACKGROUND Inaccurate arrhythmia classification by implantable cardioverter-defibrillators (ICDs) contributes to inappropriate shocks and increased health care utilization. OBJECTIVE The purpose of this study was to evaluate the ability of a novel discriminator using far-field (FF) and near-field (NF) right ventricular lead electrograms (EGMs) to differentiate ventricular tachycardia (VT) from supraventricular tachycardia (SVT) in patients with underlying conducted narrow QRS, right bundle branch block (RBBB), and left bundle branch block (LBBB). METHODS ICD interrogations were reviewed, identifying subjects with tachycardia events at least 5 beats in duration with stable morphology and cycle length. FF to NF (FF-NF) EGM intervals during tachycardia and baseline conducted rhythm were measured using digital calipers. Events with uncertain tachycardia rhythm mecha-nism were excluded. RESULTS Ninety-five subjects were included. Mean FF-NF interval during tachycardia was significantly lower during SVT than VT (25.8 +/- 12.0 ms vs 91.0 +/- 37.2 ms; P <.001). Participants with LBBB (n = 22) and RBBB (n = 21) had significantly lower mean FF-NF intervals during SVT compared with VT (LBBB 25.6 +/- 7.26 ms vs 93.1 +/- 41.5 ms; P <.001; RBBB 30.0 +/- 16.6 ms vs 101.7 +/- 34.3 ms; P <.001). In this cohort, FF-NF interval cutoff of 100 ms was 100% specific for VT discrimination regardless of underlying QRS morphology, with sensitivity of 46%, 50%, and 38% for LBBB, RBBB, and narrow QRS, respectively. CONCLUSION Prolonged FF-NF interval on intracardiac EGM during tachycardia is a highly specific discriminator for VT, regardless of baseline QRS morphology.
引用
收藏
页码:1561 / 1565
页数:5
相关论文
共 13 条
[1]   Amiodarone or an implantable cardioverter-defibrillator for congestive heart failure [J].
Bardy, GH ;
Lee, KL ;
Mark, DB ;
Poole, JE ;
Packer, DL ;
Boineau, R ;
Domanski, M ;
Troutman, C ;
Anderson, J ;
Johnson, G ;
McNulty, SE ;
Clapp-Channing, N ;
Davidson-Ray, LD ;
Fraulo, ES ;
Fishbein, DP ;
Luceri, RM ;
Ip, JH .
NEW ENGLAND JOURNAL OF MEDICINE, 2005, 352 (03) :225-237
[2]   The Healthcare Utilization and Cost of Treating Patients Experiencing Inappropriate Implantable Cardioverter Defibrillator Shocks: A Propensity Score Study [J].
Bhavnani, Sanjeev P. ;
Giedrimiene, Dalia ;
Coleman, Craig I. ;
Guertin, Danette ;
Azeem, Meena ;
Kluger, Jeffrey .
PACE-PACING AND CLINICAL ELECTROPHYSIOLOGY, 2014, 37 (10) :1315-1323
[3]   Relative timing of near-field and far-field electrograms can determine the tachyarrhythmia site of origin [J].
Caldwell, Jane ;
Gula, Lorne ;
Ali, Fariha Sadiq ;
Miranda, Rodrigo I. ;
Abdollah, Hoshiar ;
Baranchuk, Adrian ;
Michael, Kevin ;
Simpson, Christopher ;
Redfearn, Damian P. .
HEART RHYTHM, 2018, 15 (04) :530-535
[4]   Inappropriate implantable cardioverter-defibrillator shocks in MADIT II [J].
Daubert, James P. ;
Zareba, Wojciech ;
Cannom, David S. ;
McNitt, Scott ;
Rosero, Spencer Z. ;
Wang, Paul ;
Schuger, Claudio ;
Steinberg, Jonathan S. ;
Higgins, Steven L. ;
Wilber, David J. ;
Klein, Helmut ;
Andrews, Mark L. ;
Hall, W. Jackson ;
Moss, Arthur J. .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 2008, 51 (14) :1357-1365
[5]   Dual- vs. single-chamber defibrillators for primary prevention of sudden cardiac death: long-term follow-up of the Defibrillateur Automatique Implantable-Prevention Primaire registry [J].
Defaye, Pascal ;
Boveda, Serge ;
Klug, Didier ;
Beganton, Frankie ;
Piot, Olivier ;
Narayanan, Kumar ;
Perier, Marie-Cecile ;
Gras, Daniel ;
Fauchier, Laurent ;
Bordachar, Pierre ;
Algalarrondo, Vincent ;
Babuty, Dominique ;
Deharo, Jean-Claude ;
Leclercq, Christophe ;
Marijon, Eloi ;
Sadoul, Andnicolas .
EUROPACE, 2017, 19 (09) :1478-1484
[6]  
Epstein AE, 2008, CIRCULATION, V117, P2820, DOI 10.1161/CIRCUALTIONAHA.108.189741
[7]   Improved survival with an implanted defibrillator in patients with coronary disease at high risk for ventricular arrhythmia [J].
Moss, AJ ;
Hall, WJ ;
Cannom, DS ;
Daubert, JP ;
Higgins, SL ;
Klein, H ;
Levine, JH ;
Saksena, S ;
Waldo, AL ;
Wilber, D ;
Brown, MW ;
Heo, M .
NEW ENGLAND JOURNAL OF MEDICINE, 1996, 335 (26) :1933-1940
[8]   Prophylactic implantation of a defibrillator in patients with myocardial infarction and reduced ejection fraction [J].
Moss, AJ ;
Zareba, W ;
Hall, WJ ;
Klein, H ;
Wilber, DJ ;
Cannom, DS ;
Daubert, JP ;
Higgins, SL ;
Brown, MW ;
Andrews, ML .
NEW ENGLAND JOURNAL OF MEDICINE, 2002, 346 (12) :877-883
[9]  
Oginosawa Y, 2017, CIRC J, V81, P1272, DOI [10.1253/circj.CJ-17-1330, 10.1253/circj.CJ-16-1330]
[10]   Defibrillator shocks and their effect on objective and subjective patient outcomes: Results of the PainFree SST clinical trial [J].
Sears, Samuel F. ;
Rosman, Lindsey ;
Sasaki, Shingo ;
Kondo, Yusuke ;
Sterns, Laurence D. ;
Schloss, Edward J. ;
Kurita, Takashi ;
Meijer, Albert ;
Raijmakers, Judith ;
Gerritse, Bart ;
Auricchio, Angelo .
HEART RHYTHM, 2018, 15 (05) :734-740