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Relative timing of near-field and far-field electrograms can determine the tachyarrhythmia site of origin.

Abstract：

BACKGROUND:Despite improving algorithms, inappropriate shocks for supraventricular tachycardia (SVT) still occur in a significant number of patients with implantable cardioverter-defibrillators (ICDs). This makes the discovery of novel discriminators that use existing ICD hardware an attractive proposition. OBJECTIVE:We hypothesized that the delay of activation onset from the device-detected, far-field electrogram (EGM) to the near-field, bipole EGM would allow the differentiation of ventricular tachycardias (VTs) from SVTs. METHODS:Proof of principle was demonstrated by rapid pacing in the right atrium, right ventricle, and left ventricle in healthy patients undergoing atrial fibrillation ablation procedures (n = 17). Using real-life ICD recordings, the equivalent measurements were made in a derivation cohort (n = 26) and cutoff predictive values obtained. Finally, the selected values were validated in a separate group of recordings (n = 82). RESULTS:In healthy patients, significant differences in the far-field to near-field EGM activation onsets were observed between right atrial (14.7 ± 2.7 ms), right ventricular (36.3 ± 8 ms), and left ventricular (57.8 ± 10.3 ms; P < .001) pacing. In the derivation ICD cohort, the median far-field to near-field onset delay was significantly shorter in SVT (24.5 ms; interquartile range, 15.3-47.5 ms) than in VT (118.5 ms; interquartile range, 102.5-131.5 ms) (P < .001). Using a cutoff of 100 ms in the validation cohort, SVT was successfully discriminated from VT with a sensitivity and specificity of 88% and a negative predictive value of 94.2%. CONCLUSION:The delay between far-field and near-field EGMs offers a potential new discrimination tool to reduce inappropriate ICD therapies and aid interpretation of single-lead device tracings.

journal_name

Heart Rhythm

journal_title

Heart rhythm

authors

Caldwell J,Gula L,Ali FS,Miranda RI,Abdollah H,Baranchuk A,Michael K,Simpson C,Redfearn DP

doi

10.1016/j.hrthm.2017.12.015

subject

Has Abstract

pub_date

2018-04-01 00:00:00

pages

530-535

issue

4

eissn

1547-5271

issn

1556-3871

pii

S1547-5271(17)31436-4

journal_volume

15

pub_type

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