Electrogram morphology discriminators in implantable cardioverter defibrillators: A comparative evaluation

Background Morphology algorithms are currently recommended as a standalone discriminator in single‐chamber implantable cardioverter defibrillators (ICDs). However, these proprietary algorithms differ in both design and nominal programming. Objective To compare three different algorithms with nominal versus advanced programming in their ability to discriminate between ventricular (VT) and supraventricular tachycardia (SVT). Methods In nine European centers, VT and SVTs were collected from Abbott, Boston Scientific, and Medtronic dual‐ and triple‐chamber ICDs via their respective remote monitoring portals. Percentage morphology matches were recorded for selected episodes which were classified as VT or SVT by means of atrioventricular comparison. The sensitivity and related specificity of each manufacturer discriminator was determined at various values of template match percentage from receiving operating characteristics (ROC) curve analysis. Results A total of 534 episodes were retained for the analysis. In ROC analyses, Abbott Far Field MD (area under the curve [AUC]: 0.91; P