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(Circulation. 2006;113:2862-2864.)
© 2006 American Heart Association, Inc.

Editorial

Overcoming the Defects of a Virtue

Dual-Chamber Versus Single-Chamber Detection Enhancements for Implantable Defibrillator Rhythm Diagnosis: The Detect Supraventricular Tachycardia Study

Michael O. Sweeney, MD

From Brigham and Women’s Hospital, Boston, Mass.

Correspondence to Michael O. Sweeney, MD, Cardiac Arrhythmia Service, Brigham and Women’s Hospital, 75 Francis St, Boston, MA 02115. E-mail mosweeney@partners.org

Key Words: Editorials • supraventricular tachycardia • ventricular tachycardia • implantable cardioverter-defibrillators

An extract of the first 250 words of the full text is provided, because this article has no abstract.

"Mission critical" is a uniquely American cliché generally held to mean an action or series of actions essential for the success of an important endeavor. Randomized clinical trials have conclusively demonstrated that implantable cardioverter-defibrillators (ICDs) reduce mortality among appropriately selected patients who have survived an episode of life-threatening ventricular arrhythmia or are at risk for ventricular arrhythmia. The mission critical aspect of ICD operation is accurate recognition and termination of ventricular arrhythmia. Reproducibly reliable delivery of this critical series of actions is sufficient to guarantee mortal benefit.

Article p 2871

Recognition of ventricular arrhythmias is fundamentally a sequential 2-step process. The first step, sensing, requires continuous real-time recording of cardiac electrical activity that is processed and filtered to reduce noise and to exclude physiological signals that are not of interest. Practically speaking, only ventricular electrical activity is necessary for this step and could be obtained from several different recording sites (endocardium, epicardium, subcutaneous tissue). The second step, detection, requires characterization of sensed signals to inform the need for therapy. ICDs rely on the rate of sensed ventricular signals for detection and hierarchical prioritization of specific therapies. Rate-based detection alone has proved robust for accurate recognition of ventricular fibrillation (VF) because, except for preexcited atrial fibrillation (AF), virtually no other cardiac rhythm disturbance is capable of achieving similarly high ventricular rates. On the other hand, although rate-based detection alone is similarly reliable for relatively slower ventricular tachycardia (VT), it is critically flawed because (1) VT occurs across a broad range of . . . [Full Text of this Article]

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