Discrimination

Medtronic Device: ICD Field: Discrimination

Theoritical features / Basic concepts

Discrimination in Single Chamber ICDs Discrimination in Dual Chamber ICDs   ICD Discrimination ALGORITHMS When programming an ICD, particular attention should be paid to the risk of inappropriate therapies. Modern ICDs offer several advanced criteria, which, alone or combined, can discriminate VT from SVT. The “heart rate” criterion cannot safely be used alone, as its specificity for the diagnosis of ventricular tachyarrhythmias is only 60%, while its sensitivity can be easily increased to 100%. Moreover, the lower the programmed VT zone, the lower its specificity. Without other discrimination criteria, the therapy will be delivered irrespective of the origin of the tachycardia. The VF zone is typically reserved for very high rate and left without other intervening criteria, which are...

Medtronic paths associated with this specificity

Patient with ischemic cardiomyopathy implanted with a single-chamber ICD (Virtuoso VR) and presenting multiple VT episodes; this tracing details the 3 different discrimination parameters available on a single-chamber device.

Patient implanted with a single-chamber ICD (Evera XT VR) for ischemic cardiomyopathy; this tracing illustrates the new guidelines which recommends a simple chamber discrimination based solely on morphology.

Patient implanted with a dual-chamber ICD (EnTrust) for ischemic cardiomyopathy; this tracing demonstrates the limits of the programming of single-chamber parameters on a dual-chamber platform.

Patient implanted with a dual-chamber ICD for arrhythmogenic right ventricular dysplasia; this tracing shows the fundamentals of the functioning of the dual-chamber PR Logic discrimination algorithm.

Patient with ischemic cardiomyopathy implanted with a dual-chamber ICD (Evera XT DR) with slow VT episodes (125 beats/minute); programming of a slow VT zone at 520 ms; this tracing highlights the functioning of the PR Logic algorithm and the diagnosis of sinus tachycardia.

Patient with ischemic cardiomyopathy implanted with a triple-chamber ICD (InSync Sentry); this tracing shows the functioning of the PR Logic algorithm in a patient with atrial flutter.

Patient with ischemic cardiomyopathy implanted with a dual-chamber ICD (Evera XT DR); the following tracings will allow detailing the operation of the PR Logic algorithm in the setting of an episode of fast conducted AF.

Same patient as in the previous tracing.

Same patient as in the previous tracing.