Korean Circ J.  2016 Mar;46(2):179-185. 10.4070/kcj.2016.46.2.179.

Tachyarrhythmia Cycle Length in Appropriate versus Inappropriate Defibrillator Shocks in Brugada Syndrome, Early Repolarization Syndrome, or Idiopathic Ventricular Fibrillation

• Lee WS
• Kim J
• Kwon CH
• Choi JH
• Jo U
• Kim YR
• Nam GB
• Choi KJ
• Kim YH

• KMID: 2344469
• DOI: http://doi.org/10.4070/kcj.2016.46.2.179

Abstract

BACKGROUND AND OBJECTIVES
Implantable cardioverter-defibrillators (ICDs) are indicated in patients with Brugada syndrome (BS), early repolarization syndrome (ERS), or idiopathic ventricular fibrillation (IVF) who are at high risk for sudden cardiac death. The optimal ICD programming for reducing inappropriate shocks in these patients remains to be determined. We investigated the difference in the mean cycle length of tachyarrhythmias that activated either appropriate or inappropriate ICD shocks in these three patient groups to determine the optimal ventricular fibrillation (VF) zone for minimizing inappropriate ICD shocks.
SUBJECTS AND METHODS
We selected 41 patients (35 men) (mean age±standard deviation=42.6±13.0 year) who received ICD shocks between April 1996 and April 2014 to treat BS (n=24), ERS (n=9), or IVF (n=8). Clinical and ICD interrogation data were retrospectively collected and analyzed for all events with ICD shocks.
RESULTS
Of the 244 episodes, 180 (73.8%) shocks were appropriate and 64 (26.2%) were inappropriate. The mean cycle lengths of the tachyarrhythmias that activated appropriate and inappropriate shocks were 178.9±28.7 ms and 284.8±24.4 ms, respectively (p<0.001). The cutoff value with the highest sensitivity and specificity for discriminating between appropriate and inappropriate shocks was 235 ms (sensitivity, 98.4%; specificity, 95.6%). When we programmed a single VF zone of ≤270 ms, inappropriate ICD shocks were reduced by 70.5% and appropriate shocks were missed in 1.7% of these patients.
CONCLUSION
Programming of a single VF zone of ≤270 ms in patients with BS, ERS, or IVF could reduce inappropriate ICD shocks, with a low risk of missing appropriate shocks.

Keyword

Cardioverter defibrillator, implantable; Brugada syndrome; Ventricular fibrillation

MeSH Terms

Brugada Syndrome*
Death, Sudden, Cardiac
Defibrillators*
Humans
Retrospective Studies
Sensitivity and Specificity
Shock*
Tachycardia*
Ventricular Fibrillation*

Figure

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  Fig. 1 Representative electrograms of the episodes obtained upon device interrogation. (A) Appropriate ICD shock due to VF, (B) inappropriate ICD shock due to atrial fibrillation with rapid ventricular response. ICD: implantable cardioverter-defibrillator, VF: ventricular fibrillation, AMP: amplitude, HV: high voltage shock, AS: atrial sensing, STIM: stimulation (antitachycardia pacing).

• 

  Fig. 2 Distribution of the tachyarrhythmia cycle lengths of appropriate or inappropriate ICD shocks. ICD: implantable cardioverter-defibrillator.

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  Fig. 3 Mean cycle lengths of the tachyarrhythmias causing appropriate or inappropriate ICD shocks in all patients. ICD: implantable cardioverter-defibrillator.

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  Fig. 4 Best cutoff value for discriminating between appropriate and inappropriate ICD shocks (235 ms; sensitivity: 98.4%, specificity: 95.6%). ICD: implantable cardioverter-defibrillator

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