Performance of an automatic external cardioverter-defibrillator algorithm in the discrimination of supraventricular from ventricular tachycardia

An automatic external cardioverter-defibrillator (AECD) with a programmable supraventricular–ventricular tachycardia (VT) zone underwent evaluation of arrhythmia discrimination performance in the electrophysiologic laboratory during induced supraventricular tachycardia (SVT) and unipolar and bipolar atrial pacing. The AECD SVT zone was programmed so that the induced SVT rate would fall within this zone. Atrial pacing was also performed at a rate within this zone. The ability of the AECD to accurately discriminate between VT and SVT and to recommend shock delivery was assessed. A total of 98 patients underwent conventional diagnostic electrophysiologic studies (49 men, age 59 ± 19 years) with a total of 55 inducible sustained SVTs. High right atrial pacing was performed in 56 patients in unipolar and in 82 patients in bipolar fashion. In response to induced sustained SVT, the AECD correctly classified 47 episodes as nonshockable, 4 incorrectly as shockable, and 4 episodes correctly as shockable with a resultant sensitivity of 100% and specificity of 92%. Bipolar high right atrial pacing was correctly identified as nonshockable in 75 episodes, incorrectly identified as shockable in 5 episodes, and correctly identified as shockable in 2 episodes with a resultant sensitivity of 100% and specificity of 94%. The Powerheart AECD accurately discriminates SVT from VT and is expected to correctly deliver automatic external shocks rapidly in the presence of spontaneous life-threatening tachycardia and appropriately withhold therapy during SVT.