The use of signal analyses of ventricular tachycardia electrograms to predict the response of antitachycardia pacing in patients with implantable cardioverter-defibrillators

Ta Chuan Tuan, Men Tzung Lo, Yenn Jiang Lin, Wan Hsin Hsieh, Chen Lin, Norden E. Huang, Li Wei Lo, Tze Fan Chao, Jo Nan Liao, Yu Cheng Hsieh, Tsu Juey Wu*, Shih Ann Chen

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

7 Scopus citations

Abstract

ICDs and Signal Analyses Introduction Antitachycardia pacing (ATP), a quick, painless, and effective therapy available in implantable cardioverter-defibrillators (ICDs), can terminate most, but not all, sustained ventricular tachycardias (VTs). This study investigated the possible ventricular electrogram (EGM) factors for predicting the effectiveness of ATP therapy from ICD recordings. Methods and Results In this study, we analyzed 113 EGMs of VT episodes acquired from 20 patients who received ATP or shock to terminate tachyarrhythmias during follow-up after ICD implantations. The relationship between the outcome of ATP and VT EGM features (such as voltage, width, cycle length, and beat-to-beat morphologic variation) was investigated. The divergence (beat-to-beat morphologic variation) of the VT EGMs was determined by calculating the total deviation of all EGMs away from the average template after all VT EMGs were aligned. In total, 72 (63.7%) successful (Group I) and 41 (36.3%) unsuccessful (Group II) ATP therapy episodes were analyzed. The mean amplitude, cycle length, and EGM width were similar between these 2 groups (P > 0.05). A multivariate analysis demonstrated that the only predictor of successful ATP was the divergence among the VT EGMs (0.56 ± 0.32 vs 1.07 ± 0.64, P < 0.001, for Groups 1 and 2, respectively). The optimal cutoff value for determining a successful ATP therapy was 0.73 (with an area under the curve of 0.769, sensitivity of 81.9% [95% CI = 71.1-90.0], and specificity of 65.9% [95% CI = 49.4-79.9], P < 0.0001). Conclusion Signal analyses from stored EGMs of VT can predict the response of ATP therapy in patients with ICD implantations. A lesser ventricular beat-to-beat morphologic variation in the intracardiac recordings from ICDs correlated with a higher probability of a successful ATP.

Original languageEnglish
Pages (from-to)411-417
Number of pages7
JournalJournal of cardiovascular electrophysiology
Volume25
Issue number4
DOIs
StatePublished - Apr 2014

Keywords

  • antitachycardia pacing
  • electrogram
  • implantable cardioverter-defibrillator
  • signal analysis
  • ventricular tachycardia

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