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SMART algorithm in dual chamber
ICD for supraventricular tachycardia detection
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Amiran Sh. Revishvili, Max
Schaldach*, Tran Thong*.
Bakulev Institute of Cardiovascular Surgery, Moscow, Russia, *Institute for
Biomedical Engineering, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen,
Germany
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Background
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The reported incidences of inappropriate shocks in
patients with single chamber implantable cardioverter defibrillator have been as high as
25%1,2 following episodes of supraventricular
tachycardia. While it is possible, from the Holter information collected from these
shocks, to adjust the implantable devices to avoid most of them, the patient has already
been subjected to unnecessary pain. Furthermore, there is always the possibility that the
adjustment may lead to delayed detection of ventricular tachycardia episodes. Thus, it
would be highly desirable to have a detection algorithm with a set of easily programmable
parameters that can achieve reliable atrioventricular discrimination. With such a
detection system ventricular therapies will be withhold when an episode of
supraventricular tachycardia is detected. This is especially helpful to the patients since
most of these supraventricular episodes are of short duration any way and not life
threatening. With the availability of dual chamber defibrillators3-5,
such a discrimination algorithm is needed to support the development of atrial
antitachy-arrhythmia therapies.
The atrioventricular discrimination algorithm, in addition to being able to withhold
ventricular therapy, must also be capable of delivering ventricular therapy should an
episode of ventricular tachycardia occur in the middle of an on-going supraventricular
tachycardia episode.
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