What Is the Best Algorithm to Discriminate Between Supraventricular and Ventricular Tachyarrhythmias?

  • W. Jung
  • C. Wolpert
  • S. Spehl
  • B. Lüderitz
Conference paper


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 [11]. 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 [12].


Ventricular Tachycardia Ventricular Fibrillation Ventricular Tachyarrhythmia Implantable Cardioverter Defibrillator Therapy Defibrillation Threshold 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Hook BG, Marchlinski FE (1991) Value of ventricular electrogram in the diagnosis of arrhythmias precipitating electrical device therapy. J Am Coll Cardiol 19:490–499Google Scholar
  2. 2.
    Grimm W, Flores BF, Marchlinski FE (1992) Electrocardiographically documented unnecessary, spontaneous shocks in 241 patients with implantable cardioverter-defibrillators. Pacing Clin Electrophysiol 15:1667–1673PubMedCrossRefGoogle Scholar
  3. 3.
    Swerdlow CD, Chen PS, Kass RM, Allard JR, Peter CT (1994) Discrimination of ventricular tachycardia from sinus tachycardia and atrial fibrillation in a tiered-therapy cardioverter-defibrillator. J Am Coll Cardiol 23:1342–1355PubMedCrossRefGoogle Scholar
  4. 4.
    Swerdlow CD, Ahern T, Chen PS et al (1994) Underdetection of ventricular tachycardia by algorithms to enhance specificity in a tiered-therapy cardioverter-defibrillator. J Am Coll Cardiol 24:416–424PubMedCrossRefGoogle Scholar
  5. 5.
    Neuzner J, Pitschner HF, Schlepper M (1995) Programmable VT detection enhancements in implantable cardioverter defìbrillator therapy. Pacing Clin Electrophysiol 18:539–547PubMedCrossRefGoogle Scholar
  6. 6.
    Schaumann A, von zur Mühlen F, Gonska BD, Kreuzer H (1996) Enhanced detection criteria in implantable cardioverter-defibrillators to avoid inappropriate therapy. Am J Cardiol 78:42–50PubMedCrossRefGoogle Scholar
  7. 7.
    Higgins SL, Lee RS, Kramer RL (1995) Stability: an ICD detection criterion for discriminating atrial fibrillation from ventricular tachycardia. J Cardiovasc Electrophysiol 6:1081–1088PubMedCrossRefGoogle Scholar
  8. 8.
    Schuger CD, Jackson K, Russel TS, Lehmann MH (1988) Atrial sensing to augment ventricular tachycardia detection by the automatic implantable cardioverter defìbrillator: a utility study. Pacing Clin Electrophysiol 11:1456–1464PubMedCrossRefGoogle Scholar
  9. 9.
    Leong PHW, Jabri MA (1992) Arrhythmia classification using two intracardiac leads. IEEE Computer Society Press, Los Alamitos, Calif, pp 189–192 (Proceedings of Computers in Cardiology)Google Scholar
  10. 10.
    Polikaitis A, Arzbaecher R (1995) Sensitivity and specificity of a dual-chamber arrhythmia recognition algorithm for implantable devices. J Electrocardiol 27:78–83CrossRefGoogle Scholar
  11. 11.
    Geelen P, Lorga A, Chauvin M, Wellens F, Brugada P (1997) The value of DDD pacing in patients with an implantable cardioverter defibrillator. Pacing Clin Electrophysiol 20:177–181PubMedCrossRefGoogle Scholar
  12. 12.
    Wolpert C, Jung W, Lilienthal B et al (1997) Ist bei Patienten mit implantierbarem Kardioverter-Defibrillator eine AV-sequentielle Stimulation erforderlich? Systematische Untersuchung an 102 Patienten. Z Kardiol 86:315 (abstr)Google Scholar
  13. 13.
    Körte T, Jung W, Wolpert C, Spehl S, Schumacher B, Esmailzadeh B, Lüderitz B (1998) A new classification algorithm for discrimination of ventricular from supraventricular tachycardia in a dual-chamber implantable cardioverter-defibrillator. J Cardiovasc Electrophysiol 9:70–73PubMedCrossRefGoogle Scholar
  14. 14.
    Nair M, Saoudi N, Kroiss D, Letac B, for the Participating Centers of the Automatic Recognition of Arrhythmia Study Group (1997) Automatic arrhythmia identification using analysis of the atrioventricular association. Circulation 95:973–967CrossRefGoogle Scholar
  15. 15.
    Lavergne T, Daubert JC, Chauvin M et al (1997) Preliminary clinical experience with the first dual-chamber pacemaker defibrillator. Pacing Clin Electrophysiol 20:182–188PubMedCrossRefGoogle Scholar
  16. 16.
    Jung W, Wolpert C, Spehl S et al (1998) Prospective evaluation of a new arrhythmia classification algorithm for discrimination of ventricular tachycardia from supraventricular tachycardia. Pacing Clin Electrophysiol 21:890 (abstr)CrossRefGoogle Scholar

Copyright information

© Springer-Verlag Italia 2000

Authors and Affiliations

  • W. Jung
    • 1
  • C. Wolpert
    • 1
  • S. Spehl
    • 1
  • B. Lüderitz
    • 1
  1. 1.Department of Medicine-CardiologyUniversity of BonnGermany

Personalised recommendations