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...
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| Veröffentlicht in: | Journal of cardiovascular electrophysiology 2020-06, Vol.31 (6), p.1493-1506 |
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| creator | Frontera, Antonio Strik, Marc Eschalier, Romain Biffi, Mauro Pereira, Bruno Welte, Nicolas Chauvel, Remi Mondoly, Pierre Laborderie, Julien Bernis, Jean‐Paul Clementy, Nicolas Reuter, Sylvain Garrigue, Stéphane Deplagne, Antoine Vernooy, Kevin Pillois, Xavier Haïssaguerre, Michel Dubois, Remi Ritter, Philippe Bordachar, Pierre Ploux, Sylvain |
| description | 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 |
| doi_str_mv | 10.1111/jce.14518 |
| format | Article |
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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 < .001) and Boston Scientific RhythmID (AUC: 0.95; P < .001) show higher AUC than Medtronic Wavelet (AUC: 0.81; P < .001) when tested for their ability to discriminate VT from SVT. At nominal % match threshold all devices provided high sensitivity in VT identification, (91%, 100%, and 90%, respectively, for Abbott, Boston Scientific, and Medtronic) but contrasted specificities in SVT discrimination (85%, 41%, and 62%, respectively). Abbott and Medtronic's nominal thresholds were similar to the optimal thresholds. Optimization of the % match threshold improved the Boston Scientific specificity to 79% without compromising the sensitivity.
Conclusion
Proprietary morphology discriminators show important differences in their ability to discriminate SVT. How much this impact the overall discrimination process remains to be investigated.</description><identifier>ISSN: 1045-3873</identifier><identifier>EISSN: 1540-8167</identifier><identifier>DOI: 10.1111/jce.14518</identifier><identifier>PMID: 32333433</identifier><language>eng</language><publisher>United States: Wiley Subscription Services, Inc</publisher><subject>Action Potentials ; algorithm ; Algorithms ; arrhythmia ; Defibrillators ; Defibrillators, Implantable ; Diagnosis, Differential ; discrimination ; Electric Countershock - instrumentation ; Electrophysiologic Techniques, Cardiac - instrumentation ; Equipment Design ; Europe ; Heart Rate ; Humans ; implantable cardioverter defibrillator ; Morphology ; Predictive Value of Tests ; Reproducibility of Results ; Retrospective Studies ; Signal Processing, Computer-Assisted ; Stents ; Tachycardia ; Tachycardia, Supraventricular - diagnosis ; Tachycardia, Supraventricular - physiopathology ; Tachycardia, Supraventricular - therapy ; Tachycardia, Ventricular - diagnosis ; Tachycardia, Ventricular - physiopathology ; Tachycardia, Ventricular - therapy ; Telemetry - instrumentation ; Ventricle</subject><ispartof>Journal of cardiovascular electrophysiology, 2020-06, Vol.31 (6), p.1493-1506</ispartof><rights>2020 Wiley Periodicals LLC</rights><rights>2020 Wiley Periodicals LLC.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3538-7c56e67a46d672feb22dfa100943ca5667f57beb82149a9a369ac34185d174973</citedby><cites>FETCH-LOGICAL-c3538-7c56e67a46d672feb22dfa100943ca5667f57beb82149a9a369ac34185d174973</cites><orcidid>0000-0002-0372-4480 ; 0000-0003-4355-2967 ; 0000-0003-3348-6548 ; 0000-0002-7415-0787</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fjce.14518$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fjce.14518$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,776,780,1411,27901,27902,45550,45551</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32333433$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Frontera, Antonio</creatorcontrib><creatorcontrib>Strik, Marc</creatorcontrib><creatorcontrib>Eschalier, Romain</creatorcontrib><creatorcontrib>Biffi, Mauro</creatorcontrib><creatorcontrib>Pereira, Bruno</creatorcontrib><creatorcontrib>Welte, Nicolas</creatorcontrib><creatorcontrib>Chauvel, Remi</creatorcontrib><creatorcontrib>Mondoly, Pierre</creatorcontrib><creatorcontrib>Laborderie, Julien</creatorcontrib><creatorcontrib>Bernis, Jean‐Paul</creatorcontrib><creatorcontrib>Clementy, Nicolas</creatorcontrib><creatorcontrib>Reuter, Sylvain</creatorcontrib><creatorcontrib>Garrigue, Stéphane</creatorcontrib><creatorcontrib>Deplagne, Antoine</creatorcontrib><creatorcontrib>Vernooy, Kevin</creatorcontrib><creatorcontrib>Pillois, Xavier</creatorcontrib><creatorcontrib>Haïssaguerre, Michel</creatorcontrib><creatorcontrib>Dubois, Remi</creatorcontrib><creatorcontrib>Ritter, Philippe</creatorcontrib><creatorcontrib>Bordachar, Pierre</creatorcontrib><creatorcontrib>Ploux, Sylvain</creatorcontrib><title>Electrogram morphology discriminators in implantable cardioverter defibrillators: A comparative evaluation</title><title>Journal of cardiovascular electrophysiology</title><addtitle>J Cardiovasc Electrophysiol</addtitle><description>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 < .001) and Boston Scientific RhythmID (AUC: 0.95; P < .001) show higher AUC than Medtronic Wavelet (AUC: 0.81; P < .001) when tested for their ability to discriminate VT from SVT. At nominal % match threshold all devices provided high sensitivity in VT identification, (91%, 100%, and 90%, respectively, for Abbott, Boston Scientific, and Medtronic) but contrasted specificities in SVT discrimination (85%, 41%, and 62%, respectively). Abbott and Medtronic's nominal thresholds were similar to the optimal thresholds. Optimization of the % match threshold improved the Boston Scientific specificity to 79% without compromising the sensitivity.
Conclusion
Proprietary morphology discriminators show important differences in their ability to discriminate SVT. How much this impact the overall discrimination process remains to be investigated.</description><subject>Action Potentials</subject><subject>algorithm</subject><subject>Algorithms</subject><subject>arrhythmia</subject><subject>Defibrillators</subject><subject>Defibrillators, Implantable</subject><subject>Diagnosis, Differential</subject><subject>discrimination</subject><subject>Electric Countershock - instrumentation</subject><subject>Electrophysiologic Techniques, Cardiac - instrumentation</subject><subject>Equipment Design</subject><subject>Europe</subject><subject>Heart Rate</subject><subject>Humans</subject><subject>implantable cardioverter defibrillator</subject><subject>Morphology</subject><subject>Predictive Value of Tests</subject><subject>Reproducibility of Results</subject><subject>Retrospective Studies</subject><subject>Signal Processing, Computer-Assisted</subject><subject>Stents</subject><subject>Tachycardia</subject><subject>Tachycardia, Supraventricular - diagnosis</subject><subject>Tachycardia, Supraventricular - physiopathology</subject><subject>Tachycardia, Supraventricular - therapy</subject><subject>Tachycardia, Ventricular - diagnosis</subject><subject>Tachycardia, Ventricular - physiopathology</subject><subject>Tachycardia, Ventricular - therapy</subject><subject>Telemetry - instrumentation</subject><subject>Ventricle</subject><issn>1045-3873</issn><issn>1540-8167</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1kU9P3DAQxa2qCOiWQ79AZamX9hCw47_pDa0WCkLiQs-W40yoV06c2slW--0xLOVQqXOZOfz09OY9hD5Rck7LXGwdnFMuqH6HTqngpNJUqvflJlxUTCt2gj7kvCWEMknEMTphNWOMM3aKtpsAbk7xMdkBDzFNv2KIj3vc-eySH_xo55gy9iP2wxTsONs2AHY2dT7uIM2QcAe9b5MP4QX9ji-xi8Nkk539DjDsbFjKGceP6Ki3IcPZ616hn1ebh_WP6u7--mZ9eVc5JpiulBMSpLJcdlLVPbR13fWWEtJw5qyQUvVCtdDqmvLGNpbJxjrGqRYdVbxRbIW-HnSnFH8vkGczlGeg-BshLtnUrOG64U1JY4W-_INu45LG4s7UnGhBNC8prdC3A-VSzDlBb6YSjU17Q4l5LsCUAsxLAYX9_Kq4tAN0b-TfxAtwcQD--AD7_yuZ2_XmIPkEJSuQSQ</recordid><startdate>202006</startdate><enddate>202006</enddate><creator>Frontera, Antonio</creator><creator>Strik, Marc</creator><creator>Eschalier, Romain</creator><creator>Biffi, Mauro</creator><creator>Pereira, Bruno</creator><creator>Welte, Nicolas</creator><creator>Chauvel, Remi</creator><creator>Mondoly, Pierre</creator><creator>Laborderie, Julien</creator><creator>Bernis, Jean‐Paul</creator><creator>Clementy, Nicolas</creator><creator>Reuter, Sylvain</creator><creator>Garrigue, Stéphane</creator><creator>Deplagne, Antoine</creator><creator>Vernooy, Kevin</creator><creator>Pillois, Xavier</creator><creator>Haïssaguerre, Michel</creator><creator>Dubois, Remi</creator><creator>Ritter, Philippe</creator><creator>Bordachar, Pierre</creator><creator>Ploux, Sylvain</creator><general>Wiley Subscription Services, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QP</scope><scope>K9.</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-0372-4480</orcidid><orcidid>https://orcid.org/0000-0003-4355-2967</orcidid><orcidid>https://orcid.org/0000-0003-3348-6548</orcidid><orcidid>https://orcid.org/0000-0002-7415-0787</orcidid></search><sort><creationdate>202006</creationdate><title>Electrogram morphology discriminators in implantable cardioverter defibrillators: A comparative evaluation</title><author>Frontera, Antonio ; Strik, Marc ; Eschalier, Romain ; Biffi, Mauro ; Pereira, Bruno ; Welte, Nicolas ; Chauvel, Remi ; Mondoly, Pierre ; Laborderie, Julien ; Bernis, Jean‐Paul ; Clementy, Nicolas ; Reuter, Sylvain ; Garrigue, Stéphane ; Deplagne, Antoine ; Vernooy, Kevin ; Pillois, Xavier ; Haïssaguerre, Michel ; Dubois, Remi ; Ritter, Philippe ; Bordachar, Pierre ; Ploux, Sylvain</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3538-7c56e67a46d672feb22dfa100943ca5667f57beb82149a9a369ac34185d174973</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Action Potentials</topic><topic>algorithm</topic><topic>Algorithms</topic><topic>arrhythmia</topic><topic>Defibrillators</topic><topic>Defibrillators, Implantable</topic><topic>Diagnosis, Differential</topic><topic>discrimination</topic><topic>Electric Countershock - instrumentation</topic><topic>Electrophysiologic Techniques, Cardiac - instrumentation</topic><topic>Equipment Design</topic><topic>Europe</topic><topic>Heart Rate</topic><topic>Humans</topic><topic>implantable cardioverter defibrillator</topic><topic>Morphology</topic><topic>Predictive Value of Tests</topic><topic>Reproducibility of Results</topic><topic>Retrospective Studies</topic><topic>Signal Processing, Computer-Assisted</topic><topic>Stents</topic><topic>Tachycardia</topic><topic>Tachycardia, Supraventricular - diagnosis</topic><topic>Tachycardia, Supraventricular - physiopathology</topic><topic>Tachycardia, Supraventricular - therapy</topic><topic>Tachycardia, Ventricular - diagnosis</topic><topic>Tachycardia, Ventricular - physiopathology</topic><topic>Tachycardia, Ventricular - therapy</topic><topic>Telemetry - instrumentation</topic><topic>Ventricle</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Frontera, Antonio</creatorcontrib><creatorcontrib>Strik, Marc</creatorcontrib><creatorcontrib>Eschalier, Romain</creatorcontrib><creatorcontrib>Biffi, Mauro</creatorcontrib><creatorcontrib>Pereira, Bruno</creatorcontrib><creatorcontrib>Welte, Nicolas</creatorcontrib><creatorcontrib>Chauvel, Remi</creatorcontrib><creatorcontrib>Mondoly, Pierre</creatorcontrib><creatorcontrib>Laborderie, Julien</creatorcontrib><creatorcontrib>Bernis, Jean‐Paul</creatorcontrib><creatorcontrib>Clementy, Nicolas</creatorcontrib><creatorcontrib>Reuter, Sylvain</creatorcontrib><creatorcontrib>Garrigue, Stéphane</creatorcontrib><creatorcontrib>Deplagne, Antoine</creatorcontrib><creatorcontrib>Vernooy, Kevin</creatorcontrib><creatorcontrib>Pillois, Xavier</creatorcontrib><creatorcontrib>Haïssaguerre, Michel</creatorcontrib><creatorcontrib>Dubois, Remi</creatorcontrib><creatorcontrib>Ritter, Philippe</creatorcontrib><creatorcontrib>Bordachar, Pierre</creatorcontrib><creatorcontrib>Ploux, Sylvain</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Calcium & Calcified Tissue Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of cardiovascular electrophysiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Frontera, Antonio</au><au>Strik, Marc</au><au>Eschalier, Romain</au><au>Biffi, Mauro</au><au>Pereira, Bruno</au><au>Welte, Nicolas</au><au>Chauvel, Remi</au><au>Mondoly, Pierre</au><au>Laborderie, Julien</au><au>Bernis, Jean‐Paul</au><au>Clementy, Nicolas</au><au>Reuter, Sylvain</au><au>Garrigue, Stéphane</au><au>Deplagne, Antoine</au><au>Vernooy, Kevin</au><au>Pillois, Xavier</au><au>Haïssaguerre, Michel</au><au>Dubois, Remi</au><au>Ritter, Philippe</au><au>Bordachar, Pierre</au><au>Ploux, Sylvain</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Electrogram morphology discriminators in implantable cardioverter defibrillators: A comparative evaluation</atitle><jtitle>Journal of cardiovascular electrophysiology</jtitle><addtitle>J Cardiovasc Electrophysiol</addtitle><date>2020-06</date><risdate>2020</risdate><volume>31</volume><issue>6</issue><spage>1493</spage><epage>1506</epage><pages>1493-1506</pages><issn>1045-3873</issn><eissn>1540-8167</eissn><abstract>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 < .001) and Boston Scientific RhythmID (AUC: 0.95; P < .001) show higher AUC than Medtronic Wavelet (AUC: 0.81; P < .001) when tested for their ability to discriminate VT from SVT. At nominal % match threshold all devices provided high sensitivity in VT identification, (91%, 100%, and 90%, respectively, for Abbott, Boston Scientific, and Medtronic) but contrasted specificities in SVT discrimination (85%, 41%, and 62%, respectively). Abbott and Medtronic's nominal thresholds were similar to the optimal thresholds. Optimization of the % match threshold improved the Boston Scientific specificity to 79% without compromising the sensitivity.
Conclusion
Proprietary morphology discriminators show important differences in their ability to discriminate SVT. How much this impact the overall discrimination process remains to be investigated.</abstract><cop>United States</cop><pub>Wiley Subscription Services, Inc</pub><pmid>32333433</pmid><doi>10.1111/jce.14518</doi><tpages>14</tpages><orcidid>https://orcid.org/0000-0002-0372-4480</orcidid><orcidid>https://orcid.org/0000-0003-4355-2967</orcidid><orcidid>https://orcid.org/0000-0003-3348-6548</orcidid><orcidid>https://orcid.org/0000-0002-7415-0787</orcidid></addata></record> |
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| ispartof | Journal of cardiovascular electrophysiology, 2020-06, Vol.31 (6), p.1493-1506 |
| issn | 1045-3873 1540-8167 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_2394894901 |
| source | MEDLINE; Wiley Online Library Journals Frontfile Complete |
| subjects | Action Potentials algorithm Algorithms arrhythmia Defibrillators Defibrillators, Implantable Diagnosis, Differential discrimination Electric Countershock - instrumentation Electrophysiologic Techniques, Cardiac - instrumentation Equipment Design Europe Heart Rate Humans implantable cardioverter defibrillator Morphology Predictive Value of Tests Reproducibility of Results Retrospective Studies Signal Processing, Computer-Assisted Stents Tachycardia Tachycardia, Supraventricular - diagnosis Tachycardia, Supraventricular - physiopathology Tachycardia, Supraventricular - therapy Tachycardia, Ventricular - diagnosis Tachycardia, Ventricular - physiopathology Tachycardia, Ventricular - therapy Telemetry - instrumentation Ventricle |
| title | Electrogram morphology discriminators in implantable cardioverter defibrillators: A comparative evaluation |
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