Aaron R. McCabe

Improving contemporary algorithms for implantable cardioverter-defibrillator function

Implantable cardioverter-defibrillators (ICDs) have been shown in various clinical trials to prevent mortality from sudden cardiac death due to unstable rhythms or ventricular fibrillation. Modern ICDs use sophisticated algorithms to not only deliver therapy on the detection of a malignant rhythm but also reduce the incidence of inappropriate shocks through rhythm discrimination. Current algorithms for detection of malignant rhythms use sophisticated techniques such as real-time processing and analysis of electrograms from a transvenous lead system. The Rhythm ID feature in Boston Scientific ICDs is an example of one such algorithm used for rhythm discrimination. Rhythm ID uses the vector timing and correlation algorithm, which incorporates both timing as well as morphology information for supraventricular tachycardia discrimination. Clinical trials demonstrated high sensitivity and specificity of this feature in discriminating between ventricular tachycardia and supraventricular tachycardia (results published previously). On detection of the unknown rhythm (when the ventricular tachycardia rate detection criteria is met), the vector timing and correlation algorithm compares the unknown rhythm beat-by-beat to a stored template of normal sinus rhythm. The feature correlation coefficient computed over more than 8 points in the time-aligned signals is used for the comparison. The specific discrimination procedure of Rhythm ID depends on the mode (VR or DR) and on whether the test rhythm is an initial detected rhythm or a postshock rhythm. The normal sinus rhythm template against which the suspected rhythm is compared can be periodically updated. This article will cover some of the key aspects of the Rhythm ID features decision-making process and the algorithm for template update. The results of previously published clinical studies involving the algorithms performance also will be reviewed.