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Efficacy of Pacemaker Tachycardia Termination Algorithms : Is Electrophysiological Testing Alone Adequate?
Author(s) -
EHRLICH STEPHEN,
SHANDLING ADRIAN,
CRUMP RANDY,
LI CURTIS
Publication year - 1993
Publication title -
pacing and clinical electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.686
H-Index - 101
eISSN - 1540-8159
pISSN - 0147-8389
DOI - 10.1111/j.1540-8159.1993.tb04571.x
Subject(s) - medicine , reversion , tachycardia , cardiology , mean reversion , correlation , algorithm , anesthesia , statistics , mathematics , biochemistry , chemistry , gene , phenotype , geometry
Selection of an optimal pacemaker tachycardia reversion algorithm is generally performed utilizing programmed electrical stimulation (PES). Multiple tachycardias are induced and various tachycardia termination protocols are tested for reversion success. However, PES may induce nonclinical tachycardia and result in an inaccurate assessment of subsequent reversion effectiveness for spontaneous tachycardia. To investigate this question, we compared tachycardia reversion protocol success for PES‐induced tachycardia versus spontaneously occurring tachycardia in 16 patients with atrially placed Intermedics 262–12 antitachycardia pacemakers. The pacemaker has tachycardia response counters, and the reversion success was calculated from these counters. This was performed by comparing the percent of time 1° versus 2° modality use occurred; crossover to the 2° modality implied failure of the 1° modality to convert the tachycardia. PES was used to induce multiple episodes of tachycardia and spontaneous episodes of tachycardia were recorded over time by pacemaker counters. The pacemaker 1° modality success was then compared for spontaneous and induced arrhythmias. Results: A total of 53 discrete data comparisons of PES versus spontaneous tachycardia counters were performed in the 16 patients. PES reversion success occurred 85%± 22% of the time versus a spontaneous reversion success of 88%± 22%. However, the Spearman rank correlation coefficient test demonstrated nonsignificant overall correlation (P < 0.1), and Pearson correlation on an individual patient basis varied widely (r value from < 0.1 to 1.0). Conclusions: When utilizing the same termination algorithm, the percentage conversion of tachycardias occurring spontaneously and induced by PES is similar but does not correlate well overall. This suggests that PES may not be a good linear predictor of the long‐term success of antitachycardia pacing algorithms.