Electrogram morphology discriminators in implantable cardioverter defibrillators: A comparative evaluation

Antonio Frontera, Marc Strik, Romain Eschalier, Mauro Biffi, Bruno Pereira, Nicolas Welte, Remi Chauvel, Pierre Mondoly, Julien Laborderie, Jean-Paul Bernis, Nicolas Clementy, Sylvain Reuter, Stephane Garrigue, Antoine Deplagne, Kevin Vernooy, Xavier Pillois, Michel Haissaguerre, Remi Dubois, Philippe Ritter, Pierre BordacharSylvain Ploux*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


Background Morphology algorithms are currently recommended as a standalone discriminator in single-chamber implantable cardioverter defibrillators (ICDs). However, these proprietary algorithms differ in both design and nominal programming.

Objective To compare three different algorithms with nominal versus advanced programming in their ability to discriminate between ventricular (VT) and supraventricular tachycardia (SVT).

Methods In nine European centers, VT and SVTs were collected from Abbott, Boston Scientific, and Medtronic dual- and triple-chamber ICDs via their respective remote monitoring portals. Percentage morphology matches were recorded for selected episodes which were classified as VT or SVT by means of atrioventricular comparison. The sensitivity and related specificity of each manufacturer discriminator was determined at various values of template match percentage from receiving operating characteristics (ROC) curve analysis.

Results A total of 534 episodes were retained for the analysis. In ROC analyses, Abbott Far Field MD (area under the curve [AUC]: 0.91; P <.001) and Boston Scientific RhythmID (AUC: 0.95; P <.001) show higher AUC than Medtronic Wavelet (AUC: 0.81; P <.001) when tested for their ability to discriminate VT from SVT. At nominal % match threshold all devices provided high sensitivity in VT identification, (91%, 100%, and 90%, respectively, for Abbott, Boston Scientific, and Medtronic) but contrasted specificities in SVT discrimination (85%, 41%, and 62%, respectively). Abbott and Medtronic's nominal thresholds were similar to the optimal thresholds. Optimization of the % match threshold improved the Boston Scientific specificity to 79% without compromising the sensitivity.

Conclusion Proprietary morphology discriminators show important differences in their ability to discriminate SVT. How much this impact the overall discrimination process remains to be investigated.

Original languageEnglish
Pages (from-to)1493-1506
Number of pages14
JournalJournal of Cardiovascular Electrophysiology
Issue number6
Publication statusPublished - Jun 2020


  • algorithm
  • arrhythmia
  • discrimination
  • implantable cardioverter defibrillator
  • morphology


Dive into the research topics of 'Electrogram morphology discriminators in implantable cardioverter defibrillators: A comparative evaluation'. Together they form a unique fingerprint.

Cite this