Dynamic analysis of cardiac rhythms for discriminating atrial fibrillation from lethal ventricular arrhythmias

Deeptankar De Mazumder, Douglas E. Lake, Alan Cheng, Travis J. Moss, Eliseo Guallar, Robert G. Weiss, Steven R. Jones, Gordon F. Tomaselli, J. Randall Moorman

Research output: Contribution to journalArticle

22 Citations (Scopus)

Abstract

Background-Implantable cardioverter-defibrillators (ICDs), the first line of therapy for preventing sudden cardiac death in high-risk patients, deliver appropriate shocks for termination of ventricular tachycardia (VT)/ventricular fibrillation. A common shortcoming of ICDs is imperfect rhythm discrimination, resulting in the delivery of inappropriate shocks for atrial fibrillation (AF). An underexplored area for rhythm discrimination is the difference in dynamic properties between AF and VT/ventricular fibrillation. We hypothesized that the higher entropy of rapid cardiac rhythms preceding ICD shocks distinguishes AF from VT/ventricular fibrillation. Methods and Results-In a multicenter, prospective, observational study of patients with primary prevention ICDs, 119 patients received shocks from ICDs with stored, retrievable intracardiac electrograms. Blinded adjudication revealed shocks were delivered for VT/ventricular fibrillation (62%), AF (23%), and supraventricular tachycardia (15%). Entropy estimation of only 9 ventricular intervals before ICD shocks accurately distinguished AF (receiver operating characteristic curve area, 0.98; 95% confidence intervals, 0.93-1.0) and outperformed contemporary ICD rhythm discrimination algorithms. Conclusions-This new strategy for AF discrimination based on entropy estimation expands on simpler concepts of variability, performs well at fast heart rates, and has potential for broad clinical application.

Original languageEnglish (US)
Pages (from-to)555-561
Number of pages7
JournalCirculation: Arrhythmia and Electrophysiology
Volume6
Issue number3
DOIs
StatePublished - Jun 1 2013
Externally publishedYes

Fingerprint

Implantable Defibrillators
Atrial Fibrillation
Cardiac Arrhythmias
Shock
Ventricular Fibrillation
Ventricular Tachycardia
Entropy
Cardiac Electrophysiologic Techniques
Supraventricular Tachycardia
Sudden Cardiac Death
Primary Prevention
ROC Curve
Observational Studies
Heart Rate
Prospective Studies
Confidence Intervals

Keywords

  • Cardiac
  • Death
  • Defibrillators
  • ECG
  • Entropy
  • Implantable
  • Inappropriate shock
  • Nonlinear dynamics
  • Sudden
  • Tachycardia
  • Ventricular
  • Ventricular fibrillation

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Dynamic analysis of cardiac rhythms for discriminating atrial fibrillation from lethal ventricular arrhythmias. / De Mazumder, Deeptankar; Lake, Douglas E.; Cheng, Alan; Moss, Travis J.; Guallar, Eliseo; Weiss, Robert G.; Jones, Steven R.; Tomaselli, Gordon F.; Moorman, J. Randall.

In: Circulation: Arrhythmia and Electrophysiology, Vol. 6, No. 3, 01.06.2013, p. 555-561.

Research output: Contribution to journalArticle

De Mazumder, Deeptankar ; Lake, Douglas E. ; Cheng, Alan ; Moss, Travis J. ; Guallar, Eliseo ; Weiss, Robert G. ; Jones, Steven R. ; Tomaselli, Gordon F. ; Moorman, J. Randall. / Dynamic analysis of cardiac rhythms for discriminating atrial fibrillation from lethal ventricular arrhythmias. In: Circulation: Arrhythmia and Electrophysiology. 2013 ; Vol. 6, No. 3. pp. 555-561.
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