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A New Single Chamber Implantable Defibrillator with Atrial Sensing: A Practical Demonstration of Sensing and Ease of Implantation
16:40

A New Single Chamber Implantable Defibrillator with Atrial Sensing: A Practical Demonstration of Sensing and Ease of Implantation

Published on: February 28, 2012

Innovative P-wave detection for discrimination between ventricular and supraventricular tachycardia in single-chamber

Will W Xiong1, Pascal Y Karam, James D Marsh

  • 1Section of Cardiac Electrophysiology, Cardiovascular Division, University of Minnesota School of Medicine, Mayo Mail Code 508, 420 Delaware St SE, Minneapolis, MN 55455, USA. xion0602@umn.edu

Europace : European Pacing, Arrhythmias, and Cardiac Electrophysiology : Journal of the Working Groups on Cardiac Pacing, Arrhythmias, and Cardiac Cellular Electrophysiology of the European Society of Cardiology
|March 21, 2013
PubMed

Insights

Optimizing electrogram (EGM) configuration in single-chamber implantable cardioverter-defibrillators (ICDs) significantly improves P-wave detection. This novel approach aids in differentiating supraventricular tachycardia (SVT) from ventricular tachycardia (VT), enhancing diagnostic accuracy.

Area of Science:

  • Cardiology
  • Biomedical Engineering
  • Electrophysiology

Background:

  • Differentiating supraventricular tachycardia (SVT) from ventricular tachycardia (VT) is challenging in patients with single-chamber implantable cardioverter-defibrillators (ICDs) due to the absence of visible P waves.
  • Optimization of intrathoracic electrogram (EGM) configuration is crucial for improving rhythm detection and diagnosis during tachycardia.

Purpose of the Study:

  • To evaluate the effectiveness of an innovative optimization of electrogram (EGM) configuration for P-wave detection and differentiation between SVT and VT in single-chamber ICD patients.
  • To assess the diagnostic utility of the Can-SVC EGM configuration compared to the conventional Can-RV coil configuration.

Main Methods:

  • A retrospective cohort study of 140 patients undergoing single-chamber ICD implantation.
  • Analysis of EGM recordings from 61 patients with optimized EGM configuration, comparing Can-SVC and Can-RV coil configurations during sinus rhythm and tachycardia.
  • Assessment of P/QRS amplitude ratio, atrioventricular dissociation detection, and P-wave identifiability.

Main Results:

  • The Can-SVC EGM configuration demonstrated a 14-fold higher P/QRS amplitude ratio compared to the Can-RV coil configuration during sinus rhythm (P < 0.001).
  • Can-SVC configuration increased the odds of detecting atrioventricular dissociation in VT by 15-fold (OR, 15.4; P = 0.0009).
  • P-waves were markedly more identifiable in Can-SVC configuration for SVT patients (OR, 40; P = 0.0010).

Conclusions:

  • Optimized EGM configuration, specifically the Can-SVC lead, provides a novel and effective diagnostic tool for differentiating VT from SVT in single-chamber ICD patients.
  • This approach enhances P-wave recognition, improving diagnostic accuracy and potentially leading to the development of a cost-effective discrimination algorithm.
Abstract

Keywords:
Arrhythmia discriminationICDsOptimized programmingP-wave detection

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