What Is the Best Algorithm to Discriminate Between Supraventricular and Ventricular Tachyarrhythmias?
Single-chamber ventricular defibrillator implantation has been shown to be an effective and safe treatment for patients with malignant ventricular tachyarrhythmias and to significantly reduce the incidence of sudden cardiac death. However, the high incidence of inappropriate implantable cardioverter defîbrillator (ICD) therapy due to supraventricular tachycardias (SVT) is a major challenge and has been reported to affect up to 25% of patients [1, 2]. Enhanced detection criteria such as rate stability, sudden onset, and morphology assessment improve the specificity of ICD therapy, but may place the patient at risk of underdetection of ventricular tachycardia (VT) [3–7]. Recently, it has been shown that algorithms using dual-chamber sensing may significantly improve differentiation between SVT and VT [8–10]. Another beneficial effect of dualchamber ICD may be the opportunity not only to sense in the atrium, but also to pace in this chamber. Although the beneficial effects of DDD pacing are well known, most of the currently available ICDs provide only fixed ventricular antibradycardia pacing. In a recent retrospective study the need for antibradycardia pacing was analyzed in a consecutive series of 139 ICD patients . The findings of this report indicate that up to 18% of the ICD patients are in need of antibradycardia pacing, with up to 80% of these patients having an indication for DDD pacing. These results are supported by an independent analysis from our center .
KeywordsVentricular Tachycardia Ventricular Fibrillation Ventricular Tachyarrhythmia Implantable Cardioverter Defibrillator Therapy Defibrillation Threshold
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