Tachyarrhythmia discriminator for implantable cardioverter-defibrillators in bundle branch block. Heart Rhythm 2020 Sep;17(9):1561-1565
Date
05/01/2020Pubmed ID
32353586DOI
10.1016/j.hrthm.2020.04.031Scopus ID
2-s2.0-85086923422 (requires institutional sign-in at Scopus site) 1 CitationAbstract
BACKGROUND: Inaccurate arrhythmia classification by implantable cardioverter-defibrillators (ICDs) contributes to inappropriate shocks and increased health care utilization.
OBJECTIVE: The purpose of this study was to evaluate the ability of a novel discriminator using far-field (FF) and near-field (NF) right ventricular lead electrograms (EGMs) to differentiate ventricular tachycardia (VT) from supraventricular tachycardia (SVT) in patients with underlying conducted narrow QRS, right bundle branch block (RBBB), and left bundle branch block (LBBB).
METHODS: ICD interrogations were reviewed, identifying subjects with tachycardia events at least 5 beats in duration with stable morphology and cycle length. FF to NF (FF-NF) EGM intervals during tachycardia and baseline conducted rhythm were measured using digital calipers. Events with uncertain tachycardia rhythm mechanism were excluded.
RESULTS: Ninety-five subjects were included. Mean FF-NF interval during tachycardia was significantly lower during SVT than VT (25.8 ± 12.0 ms vs 91.0 ± 37.2 ms; P <.001). Participants with LBBB (n = 22) and RBBB (n = 21) had significantly lower mean FF-NF intervals during SVT compared with VT (LBBB 25.6 ± 7.26 ms vs 93.1 ± 41.5 ms; P <.001; RBBB 30.0 ± 16.6 ms vs 101.7 ± 34.3 ms; P <.001). In this cohort, FF-NF interval cutoff of 100 ms was 100% specific for VT discrimination regardless of underlying QRS morphology, with sensitivity of 46%, 50%, and 38% for LBBB, RBBB, and narrow QRS, respectively.
CONCLUSION: Prolonged FF-NF interval on intracardiac EGM during tachycardia is a highly specific discriminator for VT, regardless of baseline QRS morphology.
Author List
Kapoor R, Tyagi S, Dohmen C, Oujiri J, Roth J, Rubenstein JC, Berger MAuthors
James Oujiri MD Associate Professor in the Medicine department at Medical College of WisconsinJames A. Roth MD Associate Professor in the Medicine department at Medical College of Wisconsin
Jason C. Rubenstein MD Associate Professor in the Medicine department at Medical College of Wisconsin
MESH terms used to index this publication - Major topics in bold
AgedBundle-Branch Block
Defibrillators, Implantable
Electrocardiography
Female
Follow-Up Studies
Heart Rate
Heart Ventricles
Humans
Male
Middle Aged
Retrospective Studies
Tachycardia, Ventricular