a multifeature approach to arrhythmia discrimination for an implantable cardioverter defibrillator

Journal of Electrocardiology Vol. 30 Supplement A Multifeature Approach to Arrhythmia Discrimination for an Implantable Cardioverter Defibrillator Wi]]iam Hsu, Alan Marcovecchio, Lawrence Baumann, and Douglas Lang The ability to differentiate ventricular tachycardia (VT) from supraventricular tachycardias (SVT), such as atrial fibrillation (AF) and sinus tachycardia (ST), in an implantable cardioverter defibrillator (ICD) is important. We de- scribe a similarity-dissimilarityalgorithm (SimDis), which first filters an electrogram to obtain a second derivative- like signal. A time sequence of locally maximum positive and maximum negative values is then obtained from each filtered complex. This sequence is compared with the time sequence obtained from the patient's normal sinus rhythm complex to determine the values of the similarity and dissimilarity coordinates. The resulting coordinates locate a point in a feature plane. A decision boundary, which divides the feature plane into VT and SVT regions, is drawn based on the training data set. The rhythm is classified by therapy counters as VT or SVT from the clas- sifications of the tachycardic complexes. A total of 23 VT, 13 AF, and 1 ST episode were induced via programmed electrical stimulation or rapid pacing. Signals were record- ed from the ENDOTAK 0074/0075 leads (RV--eSVC) from 20 patients at three clinical centers. The cycle lengths are reported as mean ± SD (min, max). The mean VT cycle length was 355 -+ I03 ms (231 ms, 619 ms). The mean ventricular cycle length in AF was 805 _+ 318 ms (462 ms, 1,429 ms). The ventricular cycle length in ST was 625 ms. Using a linear decision boundary, the algorithm correctly classified 22/23 VT (96%), 13/13 AF (100%), and 1/1 ST (100%) episodes. It is concluded that while the misclassi- fication of any VT episode is of concern, this multifeature approach could complement existing detection enhance- ments in implantable cardioverter defibrillators. From Tachyarrhythrnia Research, CPI/Guidant, St. Paul, Minnesota. @I,998 Churchill Livingstone ® 0022-0736/300S-004355.00/0 124

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Journal of Electrocardiology Vol. 30 Supplement

A Mult i feature A p p r o a c h to Arrhythmia Di scr iminat ion for an Implantab le

Cardioverter Defibril lator

Wi]]iam Hsu, Alan Marcovecchio, Lawrence Baumann, and Douglas Lang

The ability to differentiate ventricular tachycardia (VT) from supraventricular tachycardias (SVT), such as atrial fibrillation (AF) and sinus tachycardia (ST), in an implantable cardioverter defibrillator (ICD) is important. We de- scribe a similarity-dissimilarity algorithm (SimDis), which first filters an electrogram to obtain a second derivative- like signal. A time sequence of locally maximum positive and maximum negative values is then obtained from each filtered complex. This sequence is compared with the time sequence obtained from the patient's normal sinus rhythm complex to determine the values of the similarity and dissimilarity coordinates. The resulting coordinates locate a point in a feature plane. A decision boundary, which divides the feature plane into VT and SVT regions, is drawn based on the training data set. The rhythm is classified by therapy counters as VT or SVT from the clas-

sifications of the tachycardic complexes. A total of 23 VT, 13 AF, and 1 ST episode were induced via programmed electrical stimulation or rapid pacing. Signals were record- ed from the ENDOTAK 0074/0075 leads (RV--eSVC) from 20 patients at three clinical centers. The cycle lengths are reported as mean ± SD (min, max). The mean VT cycle length was 355 -+ I03 ms (231 ms, 619 ms). The mean ventricular cycle length in AF was 805 _+ 318 ms (462 ms, 1,429 ms). The ventricular cycle length in ST was 625 ms. Using a linear decision boundary, the algorithm correctly classified 22/23 VT (96%), 13/13 AF (100%), and 1/1 ST (100%) episodes. It is concluded that while the misclassi- fication of any VT episode is of concern, this multifeature approach could complement existing detection enhance- ments in implantable cardioverter defibrillators.

From Tachyarrhythrnia Research, CPI/Guidant, St. Paul, Minnesota. @I,998 Churchill Livingstone ® 0022-0736/300S-004355.00/0

124

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