S-113
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Inappropriate ICD
therapies-incidence, causes and prevention by programming stability and onset criteria
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Max Weber, Martin Borggrefe,
Günter Breithardt, Michael Block.
Department of Cardiology and Angiology, Institute for Arteriosclerosis Research,
Hospital of the Westfälische Wilhelms-University, Münster, Germany
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Abstract
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Shocks or antitachycardia pacing for rhythms other
than ventricular tachycardia or ventricular fibrillation are the most frequent adverse
events in patients with implantable cardioverter defibrillator (ICD). They are painful for
the patient, cause battery depletion and may induce dangerous or even fatal ventricular
arrhythmias. Atrial fibrillation with rapid ventricular response and sinus tachycardia are
the most common cause of inappropriate ICD therapies.
In addition to the rate detection criterion, multiple enhanced detection criteria are
offered to discriminate these supraventricular tachyarrhythmias from slow ventricular
tachycardia in current ICDs. The rate stability criterion distinguishes ventricular
tachycardias from atrial fibrillation, the onset criterion discriminates ventricular
tachycardias from sinus tachycardia. These detection criteria are rarely used routinely
after ICD implantation, because of the potential risk of underdetection of ventricular
tachycardia. In patients with a history of atrial fibrillation, a high heart rate at peak
exercise or a low ventricular tachycardia detection rate, activation of stability and
onset criterion should be considered directly after ICD implantation.
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Key Words
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Implantable cardioverter defibrillator -
therapy
ICD inappropriate incidences, detection criteria, supraventricular tachycardia, prevention
of inappropriate incidences, stability criteria, onset criteria, R
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