Spectral methods to distinguish ventricular fibrillation from artefact in implantable cardioverter-defibrillators

Despite the proven benefit of implantable cardioverter-defibrillators (ICDs), inappropriate shocks remain a significant problem. Recent trends have shown an increased incidence of lead failure and an increased exposure of devices to extreme electromagnetic interference environments.

The goal of the current study is to evaluate the spectral characteristics of ventricular fibrillation (VF) detected in an ICD at time of defibrillation threshold testing and use of the findings to predict event types from a population of clinical VF and artefact events.

A modelling group was created from induced VF and artefact events at time of ICD implantation and DFT testing. Power spectral density evaluation was performed on each event and used to calculate an energy ratio (ER; the ratio of energy under the first three harmonics to the entire spectrum). The model was then applied to a database of clinical VF and artefact events to determine its sensitivity and specificity. The far-field ER of the modelling group was significantly larger for VF (0.888 ± 0.110) than artefact (0.265 ± 0.156, P < 0.0001). In the test group, the far-field ER of VF (0.882 ± 0.088) was also significantly larger than artefact (0.344 ± 0.128, P < 0.0001). At a cut-off of >0.526, the far-field ER had a sensitivity of 100% [confidence interval (CI) 100-100%] and a specificity of 92.4% (CI 84.9-98.5%) to distinguish clinical VF from clinical artefact.

Far-field signal during VF detected by an ICD has a distinct spectral pattern that can distinguish VF from artefact.