Evaluation of techniques for recognition of ventricular arrhythmias by implanted devices

Three methods of electrogram analysis have been investigated: rate, irregularity, and amplitude distribution. In 35 episodes in 19 patients, these three algorithms were applied to 15 s recorded passages of ventricular electrograms during supraventricular tachycardia (N=11), ventricular tachycardia (N=11), and ventricular fibrillation (N=13). Each was individually paired with a recording of sinus rhythm from the same patient. Each algorithm was successful at distinguishing the tachyarrhythmias from sinus rhythm at one or more levels of algorithm parameterization. Rate alone discriminated supraventricular tachycardia from ventricular fibrillation but did not distinguish between supraventricular and ventricular tachycardia. Rate combined with irregularity distinguished between ventricular tachycardia and ventricular fibrillation, but did not discriminate between ventricular and supraventricular tachycardia. It is concluded that algorithms based on rate, irregularity, and amplitude distribution analysis of ventricular electrograms may distinguish sinus rhythm from tachyarrhythmias, but may not distinguish among tachyarrhythmias.<<ETX>>

[1]  R Wainwright,et al.  Ideal Atrial Lead Positioning to Detect Retrograde Atrial Depolarization by Digitization and Slope Analysis of the Atrial Electrogram , 1984, Pacing and clinical electrophysiology : PACE.

[2]  P R Reid,et al.  The Automatic Implantable Defibrillator , 1982, Pacing and clinical electrophysiology : PACE.

[3]  D. Echt,et al.  Potential Hazards of Implanted Devices for the Electrical Control of Tachyarrhythmias , 1984, Pacing and clinical electrophysiology : PACE.

[4]  R. Arzbaecher,et al.  Development of an automatic implanted drug infusion system for the management of cardiac arrhythmias , 1988, Proc. IEEE.

[5]  A. Camm,et al.  Detection of Pathological Tachycardia by Analysis of Electrogram Morphology , 1986, Pacing and clinical electrophysiology : PACE.

[6]  A. Camm,et al.  Tachycardia Recognition by Implantable Electronic Devices , 1987, Pacing and clinical electrophysiology : PACE.

[7]  R. Arzbaecher,et al.  Diagnosis of Atrial Fibrillation Using Electrograms from Chronic Leads: Evaluation of Computer Algorithms , 1988, Pacing and clinical electrophysiology : PACE.

[8]  R Arzbaecher,et al.  Tachycardia Detection in Implantable Antitachycardia Devices , 1984, Pacing and clinical electrophysiology : PACE.

[9]  R Arzbaecher,et al.  A Single Atrial Extrastimulus Can Distinguish Sinus Tachycardia from 1:1 Paroxysmal Tachycardia , 1986, Pacing and clinical electrophysiology : PACE.

[10]  A. Sahakian,et al.  Computer Discrimination of Atrial Fibrillation and Regular Atrial Rhythms from Intra‐Atrial Electrograms , 1988, Pacing and clinical electrophysiology : PACE.

[11]  P E Oyer,et al.  Clinical experience, complications, and survival in 70 patients with the automatic implantable cardioverter/defibrillator. , 1985, Circulation.