TY - JOUR
T1 - Electrogram morphology discriminators in implantable cardioverter defibrillators
T2 - A comparative evaluation
AU - Frontera, Antonio
AU - Strik, Marc
AU - Eschalier, Romain
AU - Biffi, Mauro
AU - Pereira, Bruno
AU - Welte, Nicolas
AU - Chauvel, Remi
AU - Mondoly, Pierre
AU - Laborderie, Julien
AU - Bernis, Jean-Paul
AU - Clementy, Nicolas
AU - Reuter, Sylvain
AU - Garrigue, Stephane
AU - Deplagne, Antoine
AU - Vernooy, Kevin
AU - Pillois, Xavier
AU - Haissaguerre, Michel
AU - Dubois, Remi
AU - Ritter, Philippe
AU - Bordachar, Pierre
AU - Ploux, Sylvain
N1 - Funding Information:
This study received financial support from the French Government as part of the “Investments of the Future” program managed by the National Research Agency (ANR) (Grant no. ANR‐10‐IAHU‐04).
Publisher Copyright:
© 2020 Wiley Periodicals LLC
PY - 2020/6
Y1 - 2020/6
N2 - 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.
AB - 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.
KW - algorithm
KW - arrhythmia
KW - discrimination
KW - implantable cardioverter defibrillator
KW - morphology
KW - SUPRAVENTRICULAR TACHYCARDIA
KW - VENTRICULAR-TACHYCARDIA
KW - RHYTHM DISCRIMINATION
KW - DUAL-CHAMBER
KW - ALGORITHM
U2 - 10.1111/jce.14518
DO - 10.1111/jce.14518
M3 - Article
C2 - 32333433
SN - 1045-3873
VL - 31
SP - 1493
EP - 1506
JO - Journal of Cardiovascular Electrophysiology
JF - Journal of Cardiovascular Electrophysiology
IS - 6
ER -