Sensing and detection in Medtronic implantable cardioverter defibrillators

Ensuring sensing and detection of ventricular tachycardia (VT) and ventricular fibrillation (VF) was a prerequisite for the clinical trials that established the survival benefit of implantable cardioverter defibrillators (ICDs). However, for decades, a high incidence of unnecessary shocks limited patients' and physicians' acceptance of ICD therapy. Oversensing, misclassification of supraventricular tachycardia (SVT) as VT, and self-terminating VT accounted for the vast majority of unnecessary shocks. Medtronic ICDs utilize sensitive baseline settings with minimal blanking periods to ensure accurate sensing of VF, VT, and SVT electrograms. Programmable algorithms reject oversensing caused by far-field R waves, T waves, and non-physiologic signals caused by lead failure. A robust hierarchy of SVT-VT discriminators minimize misclassification of SVT as VT. These features, combined with evidence-based programming, have reduced the 1‑year inappropriate shock rate to 1.5 % for dual-/triple-chamber ICDs and to 2.5 % for single-chamber ICDs.