Differentiation of ventricular tachycardia from ventricular fibrillation using intraventricular electrogram morphology

Abstract

Implantable antitachycardia devices are now capable of providing "ramp" therapy including antitachycardia pacing and low- and high-energy cardioversion for sustained ventricular tachycardia (VT) in addition to defibrillation of ventricular fibrillation (VF).1,2 Appropriate therapy, however, is dependent on correct identification of VT and VF. Because of variations in ventricular electrographic amplitude during VF, currently implanted devices are unable to consistently detect consecutive ventricular depolarizations during VF.3 As a result, the rate criteria for VF detection may sometimes overlap with the rate criteria used for VT detection. Morphologic analysis of intracavitary ventricular electrograms using correlation waveform analysis has been demonstrated in previous studies to be effective in discriminating normal sinus rhythm from VT, paroxysmal bundle branch block of supraventricular origin, and retrograde atrial activation. 4,7 Whether VF is distinguishable from sinus rhythm and VT with a similar method has not been determined. This study examined whether VT and VF can be distinguishable from sinus rhythm and from each other by correlation waveform analysis of intracavitary ventricular electrograms.