Detection and discrimination of tachycardia in ICDs manufactured by St. Jude Medical

Modern implantable cardioverter/defibrillator (ICD) systems offer a multitude of algorithms to optimize performance in sensing and tachycardia detection even in difficult circumstances (e. g., ventricular tachycardia during supraventricular tachycardia, fine ventricular fibrillation with intermittent undersensing), to reliably discriminate sustained ventricular tachyarrhythmia from noise, nonsustained and supraventricular tachyarrhythmia, and to limit shock therapy only to those arrhythmias that definitely need to be treated by a shock. A disadvantage of these multiple algorithms is the complexity of annotated tracings that makes it sometimes difficult to understand why the ICD did what it did. If a tachycardia classification was wrong, it may be thus difficult to find the best way to reprogram the device to avoid another misclassification. This review explains in detail the algorithms used for tachycardia detection, discrimination, and prevention of inappropriate therapy in single- and dual-chamber ICDs manufactured by St. Jude Medical. Knowledge of these features may help to optimize ICD treatment in patients fitted with these devices.