Dual-chamber versus single-chamber detection enhancements for implantable defibrillator rhythm diagnosis: The detect supraventricular tachycardia study

Paul A. Friedman*, Robyn L. McClelland, William R. Bamlet, Helbert Acosta, David Kessler, Thomas M. Munger, Neal G. Kavesh, Mark Wood, Emile Daoud, Ali Massumi, Claudio Schuger, Stephen Shorofsky, Bruce Wilkoff, Michael Glikson

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

BACKGROUND - Delivery of inappropriate shocks caused by misdetection of supraventricular tachycardia (SVT) remains a substantial complication of implanted cardioverter/defibrillator (ICD) therapy. Whether use of optimally programmed dual-chamber ICDs lowers this risk compared with that in single-chamber ICDs is not clear. METHODS AND RESULTS - Subjects with a clinical indication for ICD (n=400) at 27 participating centers received dual-chamber ICDs and were randomly assigned to strictly defined optimal single- or dual-chamber detection in a single-blind manner. Programming minimized ventricular pacing. The primary end point was the proportion of SVT episodes inappropriately detected from the time of programming until crossover or end of study. On a per-episode basis, 42% of the episodes in the single-chamber arm and 69% of the episodes in the dual-chamber arm were due to SVT. Mortality (3.5% in both groups) and early study withdrawal (14% single-chamber, 11% dual-chamber) were similar in both groups. The rate of inappropriate detection of SVT was 39.5% in the single-chamber detection arm compared with 30.9% in the dual-chamber arm. The odds of inappropriate detection were decreased by almost half with the use of the dual-chamber detection enhancements (odds ratio, 0.53; 95% confidence interval, 0.30 to 0.94; P=0.03). CONCLUSIONS - Dual-chamber ICDs, programmed to optimize detection enhancements and to minimize ventricular pacing, significantly decrease inappropriate detection.

Original languageEnglish
Pages (from-to)2871-2879
Number of pages9
JournalCirculation
Volume113
Issue number25
DOIs
StatePublished - Jun 2006
Externally publishedYes

Keywords

  • Arrhythmia
  • Defibrillation
  • Heart arrest
  • Tachyarrhythmias

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