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Archives of cardiovascular diseases
Volume 107, n° 5
pages 308-318 (mai 2014)
Doi : 10.1016/j.acvd.2014.03.006
Received : 27 February 2014 ;  accepted : 28 Mars 2014
Programming implantable cardioverter-defibrillators in primary prevention: Higher or later
Programmation des défibrillateurs implantables en prévention primaire : plus haut ou plus tard

Figure 1

Figure 1 : 

Biotronik SMART detection algorithm for dual-chamber implantable cardioverter-defibrillators. Atrial (PP intervals) and ventricular (RR intervals) cycle lengths are first compared; the rhythm is then checked for stability (RR, PP and PR intervals) in the RR=PP diagnostic branch, and for multiplicity (N:1 atrioventricular association) in the RR>PP branch. The RR<PP branch is diagnostic for ventricular tachycardia (VT). SVT: supraventricular tachycardia.

Figure 2

Figure 2 : 

Boston Scientific Rhythm ID detection algorithm for dual-chamber implantable cardioverter-defibrillators. Diagnosis of ventricular tachycardia (VT) requires either a higher ventricular rate (V rate) than atrial rate (A rate) or a non-correlated morphology associated with stable RR intervals. SVT: supraventricular tachycardia; VTC: vector timing and correlation.

Figure 3

Figure 3 : 

Medtronic enhanced PR Logic/Wavelet detection algorithm for dual-chamber implantable cardioverter-defibrillators. Tachyarrhythmias are classified according to prespecified patterns, according to atrioventricular (AV) relationship, morphology and regularity. A far-field R-wave (FFRW) algorithm is also used to discriminate ventriculoatrial crosstalk oversensing. A: atrial; AF: atrial fibrillation; ST: sinus tachycardia; SVT: supraventricular tachycardia; V: ventricular; VT: ventricular tachycardia.

Figure 4

Figure 4 : 

St. Jude Medical Discrimination algorithm for dual-chamber implantable cardioverter-defibrillators. Three decision branches according to atrioventricular relationship are initially used; discrimination is then performed using programmable single-chamber algorithms (morphology, sudden onset and stability). Initial cavity (chamber onset, atrial [A] or ventricular [V]) helps to discriminate 1:1 atrial tachycardia in the A=V branch. AVA: atrial ventricular association; MD match: morphology similar to template; SVT: supraventricular tachycardia; VT: ventricular tachycardia.

Figure 5

Figure 5 : 

Sorin Group PARAD+ detection algorithm for dual-chamber implantable cardioverter-defibrillators. Discrimination is based on analysis of stability, PR association (N:1 atrioventricular association), long cycle occurrence (VTLC), sudden onset and chamber onset (atrial [A] or ventricular [V]), in this specific order. AF: atrial fibrillation; AFl: atrial flutter; AT: atrial tachycardia ST: sinus tachycardia; VT: ventricular tachycardia.

Figure 6

Figure 6 : 

Examples of programming strategies in primary prevention patients. A. Long-delay programming requires up to three zones: a monitoring zone, a ventricular tachycardia (VT) zone with a number of detection intervals (NDI) of 30 or more below 200beats per minute (bpm) (≥10s detection time), which might even be extended up to 60s as in MADIT-RIT, and a ventricular fibrillation (VF) zone. Antitachycardia pacing (ATP) should also be prioritized before shocks below 200bpm. Over 200bpm, programming an FVT zone with ATP up to 250bpm is also possible. B. High-rate cut-off programming uses a monitoring zone below 200bpm, and a shock zone above. ATP burst should be used before or during charging in the shock zone.

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