Advertisement

Performance of an automatic external cardioverter-defibrillator algorithm in the discrimination of supraventricular from ventricular tachycardia

      Abstract

      An automatic external cardioverter-defibrillator (AECD) with a programmable supraventricular–ventricular tachycardia (VT) zone underwent evaluation of arrhythmia discrimination performance in the electrophysiologic laboratory during induced supraventricular tachycardia (SVT) and unipolar and bipolar atrial pacing. The AECD SVT zone was programmed so that the induced SVT rate would fall within this zone. Atrial pacing was also performed at a rate within this zone. The ability of the AECD to accurately discriminate between VT and SVT and to recommend shock delivery was assessed. A total of 98 patients underwent conventional diagnostic electrophysiologic studies (49 men, age 59 ± 19 years) with a total of 55 inducible sustained SVTs. High right atrial pacing was performed in 56 patients in unipolar and in 82 patients in bipolar fashion. In response to induced sustained SVT, the AECD correctly classified 47 episodes as nonshockable, 4 incorrectly as shockable, and 4 episodes correctly as shockable with a resultant sensitivity of 100% and specificity of 92%. Bipolar high right atrial pacing was correctly identified as nonshockable in 75 episodes, incorrectly identified as shockable in 5 episodes, and correctly identified as shockable in 2 episodes with a resultant sensitivity of 100% and specificity of 94%. The Powerheart AECD accurately discriminates SVT from VT and is expected to correctly deliver automatic external shocks rapidly in the presence of spontaneous life-threatening tachycardia and appropriately withhold therapy during SVT.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Cardiology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Lemire J.G.
        • Johnson A.L.
        Is cardiac resuscitation worthwhile? A decade of experience.
        N Engl J Med. 1972; 286: 970-972
        • Saklayen M.
        • Liss H.
        • Markert R.
        In-hospital cardiopulmonary resuscitation.
        Cardiopulmon Resus. 1995; 74: 163-175
        • Schneider A.P.
        • Nelson D.J.
        • Brown D.D.
        In-hospital cardiopulmonary resuscitation.
        J Am Board Fam Pract. 1993; 6: 91-101
        • Brenner B.E.
        • Kauffmann J.
        Response to cardiac arrests in a hospital setting.
        Resuscitation. 1996; 31: 17-23
        • Dumot J.
        • Burval B.S.
        • Sprung J.
        • Waters J.
        • Mraovic B.
        • Karafa M.
        • Mascha E.
        • Bourke D.
        Outcome of adult cardiopulmonary resuscitations at a tertiary referral center including results of “limited” resuscitations.
        Arch Intern Med. 2001; 161: 1751-1758
        • Kaye W.
        • Mancini M.E.
        Improving outcome from cardiac arrest in the hospital with a reorganized and strengthened chain of survival.
        Resuscitation. 1996; 31: 181-186
        • Lazzam C.
        • McCans J.L.
        Predictors of survival of in-hospital cardiac arrest.
        Can J Cardiol. 1991; 7: 113-116
      1. Mattioni TA, Brodsky M, Riggio D, Allen B, Fisher J, Ybarra R, Lin D. Enhanced response times to tachyarrhythmias using a new automatic external cardioverter-defibrillator. Eur J Cardiac Pacing Electrophysiol 1994;4:671

        • Mattioni T.A.
        • Nademanee K.
        • Brodsky M.
        • Fisher J.
        • Riggio D.
        • Allen B.
        • Welch S.
        • Ybarra R.
        • Lin D.
        • Dean E.
        Initial clinical experience with a fully automatic in-hospital external cardioverter-defibrillator.
        PACE. 1999; 22: 1648-1655
      2. Martinez-Rubio A, Kanaan N, Borggrefe M, Block M, Makijarvi M, Fedele F, Pappone C, Haverkamp W, Merino JL, Esquivas GB, Cinca J, for the European Powerheart Investigators. Advances for treating in-hospital cardiac arrest: safety and effectiveness of a new automatic external cardioverter-defibrillator. J Am Coll Cardiol 2003;41:627–632.