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

• Published in: Circulation (New York, N.Y.) Vol. 113; no. 25; pp. 2871 - 2879
• Main Authors: FRIEDMAN, Paul A, MCCLELLAND, Robyn L, SCHUGER, Claudio, SHOROFSKY, Stephen, WILKOFF, Bruce, GLIKSON, Michael, BAMLET, William R, ACOSTA, Helbert, KESSLER, David, MUNGER, Thomas M, KAVESH, Neal G, WOOD, Mark, DAOUD, Emile, MASSUMI, Ali
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins 27-06-2006
• Subjects: Aged; Arrhythmias, Cardiac - diagnosis; Arrhythmias, Cardiac - physiopathology; Arrhythmias, Cardiac - therapy; Atrioventricular Node - physiology; Biological and medical sciences; Blood and lymphatic vessels; Cardiac Pacing, Artificial - methods; Cardiology. Vascular system; Cardiovascular system; Confidence Intervals; Cross-Over Studies; Defibrillators, Implantable - adverse effects; Defibrillators, Implantable - standards; Diagnosis, Differential; Diseases of the lymphatic vessels; Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous; Electric Countershock - instrumentation; Electric Countershock - methods; Electrocardiography; Electrophysiologic Techniques, Cardiac - methods; Equipment Design; Equipment Failure; Female; Heart Rate - physiology; Humans; Male; Medical sciences; Middle Aged; Pharmacology. Drug treatments; Sensitivity and Specificity; Single-Blind Method; Tachycardia, Supraventricular - diagnosis; Tachycardia, Supraventricular - physiopathology; Tachycardia, Supraventricular - therapy; Tachycardia, Ventricular - diagnosis; Tachycardia, Ventricular - physiopathology; Tachycardia, Ventricular - therapy; Time Factors; Vasodilator agents. Cerebral vasodilators; Ventricular Fibrillation - diagnosis; Ventricular Fibrillation - physiopathology; Ventricular Fibrillation - therapy; Cardiocirculatory arrest; Arrhythmia; Cardiovascular disease; Paroxysmal supraventricular tachycardia; Medical screening; Excitability disorder; Heart disease; Diagnosis; heart arrest; Defibrillation; Comparative study; tachyarrhythmias; Defibrillator
• ISSN: 0009-7322; 1524-4539
• DOI: 10.1161/CIRCULATIONAHA.105.594531

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.
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).
Dual-chamber ICDs, programmed to optimize detection enhancements and to minimize ventricular pacing, significantly decrease inappropriate detection.