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(Circulation. 2006;113:2871-2879.)
© 2006 American Heart Association, Inc.

Arrhythmia/Electrophysiology

Dual-Chamber Versus Single-Chamber Detection Enhancements for Implantable Defibrillator Rhythm Diagnosis

The Detect Supraventricular Tachycardia Study

Paul A. Friedman, MD; Robyn L. McClelland, PhD; William R. Bamlet, MS; Helbert Acosta, MD; David Kessler, MD; Thomas M. Munger, MD; Neal G. Kavesh, MD; Mark Wood, MD; Emile Daoud, MD; Ali Massumi, MD; Claudio Schuger, MD; Stephen Shorofsky, MD; Bruce Wilkoff, MD; Michael Glikson, MD

From the Division of Cardiovascular Diseases (P.A.F., T.M.M.) and the Division of Biostatistics (R.L.M., W.R.B.), Mayo Clinic, Rochester, Minn; Electrophysiology, Trinity Medical Center, Rock Island, Ill (H.A.); Electrophysiology and Cardiac Pacing, Austin Heart, Austin, Tex (D.K.); Cardiology/Electrophysiology, Watson Clinic, Lakeland, Fla (N.G.K.); Internal Medicine/Cardiology, Virginia Commonwealth University, Richmond (M.W.); Cardiovascular Disease, MidWest Research Foundation, Riverside Methodist Hospital, Columbus, Ohio (E.D.); Center for Cardiac Arrhythmias and Electrophysiology, Texas Heart Institute, Houston (A.M.); Cardiology, Henry Ford Hospital, Detroit, Mich (C.S.); Maryland Heart Center, University of Maryland Medical Center, Baltimore (S.S.); Cardiovascular Disease, The Cleveland Clinic Foundation, Cleveland, Ohio (B.W.); and Electrophysiology and Pacing, Heart Institute, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel (M.G.).

Correspondence to Paul A. Friedman, MD, Division of Cardiovascular Diseases, Mayo Clinic, 200 First St SW, Rochester, MN 55905.

Received October 19, 2005; revision received February 17, 2006; accepted April 7, 2006.

Background— Delivery of inappropriate shocks caused by misdetection of supraventricular tachycardia (SVT) remains a substantial complication of implanted cardioverter/defibrillator (ICD) therapy. Whether use of optimally programmed dual-chamber ICDs lowers this risk compared with that in single-chamber ICDs is not clear.

Methods and Results— Subjects with a clinical indication for ICD (n=400) at 27 participating centers received dual-chamber ICDs and were randomly assigned to strictly defined optimal single- or dual-chamber detection in a single-blind manner. Programming minimized ventricular pacing. The primary end point was the proportion of SVT episodes inappropriately detected from the time of programming until crossover or end of study. On a per-episode basis, 42% of the episodes in the single-chamber arm and 69% of the episodes in the dual-chamber arm were due to SVT. Mortality (3.5% in both groups) and early study withdrawal (14% single-chamber, 11% dual-chamber) were similar in both groups. The rate of inappropriate detection of SVT was 39.5% in the single-chamber detection arm compared with 30.9% in the dual-chamber arm. The odds of inappropriate detection were decreased by almost half with the use of the dual-chamber detection enhancements (odds ratio, 0.53; 95% confidence interval, 0.30 to 0.94; P=0.03).

Conclusions— Dual-chamber ICDs, programmed to optimize detection enhancements and to minimize ventricular pacing, significantly decrease inappropriate detection.

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CLINICAL PERSPECTIVE

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