Algorithm-Based Screening May Improve Patient Selection for the Subcutaneous Implantable Defibrillator.

OBJECTIVES

The study sought to describe the concept of algorithm-based screening with an external subcutaneous implantable cardioverter-defibrillator (S-ICD) to evaluate sensing using the rhythm discrimination algorithm of the device.

BACKGROUND

In a proportion of patients, screening for S-ICD therapy with the dedicated screening tool results in false negative and false positive results.

METHODS

Both patients who failed the standard screening and who passed with abnormal baseline ECGs were screened with an external S-ICD to evaluate sensing at rest and during exercise in all 3 sensing vectors (algorithm-based screening). Patients with adequate sensing were implanted with an S-ICD. Follow-up data regarding (in)appropriate shocks was collected.

RESULTS

Algorithm-based screening was performed in 15 patients. Group 1 consists of 8 who failed standard screening and Group 2 consists of 7 who passed and had abnormal ECGs. Six of 8 who failed standard screening in all sensing vectors demonstrated adequate sensing with the external S-ICD and were implanted with an S-ICD. Of these 6 implanted patients in Group 1, 1 inappropriate shock was observed duration median of 17 months' follow-up and 2 episodes of ventricular fibrillation were successfully treated. Of the 7 patients in Group 2, who passed standard screening, 2 demonstrated inadequate sensing during additional screening with the external S-ICD. No appropriate or inappropriate shocks were observed in Group 2 during 10 months' follow-up.

CONCLUSIONS

Algorithm-based screening with the external S-ICD may improve patient selection and reduce the number of false positive and false negative screening results of the standard screening method.