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Background: Implantable cardioverter defibrillator (ICD) use is increasing in young patients and is frequently complicated by inappropriate device discharges (IDs), leading to discomfort, anxiety and, potentially, proarrhythmia. Dual-chamber (DC) ICDs may decrease IDs by improving rhythm discrimination, but are associated with increased size, expense, and implant complications. We examined whether the frequency of IDs was the same in dual- and single-chamber (SC) ICDs in young patients. Methods: A multicenter review of patients ≤30 years of age with ICDs was performed. Demographic data and number of appropriate discharges (ADs) and IDs were collected. ADs and IDs were categorized after review of the episode by the primary electrophysiologist. Results: Of 168 subjects (SC = 52; female = 76), 41 patients received 139 ADs, while 35 patients received 159 IDs. There were no differences related to gender or primary diagnosis, but patients with SC versus DC devices were younger (12.3 ± 5.0 years vs 14.9 ± 4.4 years, P < 0.0001) at implant. SC and DC devices were implanted with the same frequency for primary and secondary prevention. There were no significant differences in the incidence of IDs or ADs between the patients with SC or DC devices (AD: 12/52 SC vs 29/116 DC, P = 0.79; ID 7/52 SC vs 28/116 DC, P = 0.13). Conclusion: In this cohort of young patients, DC ICDs did not provide added protection from IDs. Hence, the added complexity and cost of an atrial lead appear unwarranted if used solely for assistance with rhythm discrimination in young patients. [ABSTRACT FROM AUTHOR]

Summary: Objective: Electrocardiographic (ECG) rhythm analysis algorithms for cardiac rhythm analysis in automated external defibrillators (AEDs) have been tested against pediatric patient rhythms (patients ≤8 years old) using adult ECG algorithm criteria. However these adult algorithms may fail to detect non-shockable pediatric tachycardias because they do not account for the difference in the rates of normal sinus rhythm and typical tachyarrhythmias in childhood. Methods: This study was designed to define shockable and non-shockable rhythm detection criteria specific to pediatric patients to create a pediatric rhythm database of annotated rhythms, to develop a pediatric-based AED rhythm analysis algorithm, and to test the algorithm''s accuracy. Pediatric rhythm detection criteria were defined for coarse ventricular fibrillation, rapid ventricular tachycardia, and non-shockable rhythms, including pediatric supraventricular tachycardia. Pediatric rhythms were collected as sustained, classifiable, rhythms ≥9s in length, and were annotated by pediatric electrophysiologists as clinically shockable or non-shockable based on pediatric criteria. Rhythms were placed into a pediatric rhythm database; each rhythm was converted to digitally accessible, public-domain, MIT rhythm data format. The database was used to evaluate a pediatric-based AED rhythm analysis algorithm. Results: Electrocardiographic rhythms from 198 children were recorded. There were 120 shockable rhythms from 49 patients (sensitivity; coarse ventricular fibrillation: 42 rhythms, 100%; rapid ventricular tachycardia: 78 rhythms, 94%), for combined sensitivity of 96.0% (115/120). There were 585 non-shockable rhythms from 155 patients (specificity normal sinus: 208 rhythms, 100%; asystole: 29 rhythms, 100%; supraventricular tachycardia: 161 rhythms, 99%; other arrhythmias: 187 rhythms, 100%), for combined specificity of 99.7% (583/585). Overall accuracy for shockable and non-shockable rhythms was 99.0% (702/709). Conclusions: New pediatric rhythm detection criteria were defined and analysis based on these criteria demonstrated both high sensitivity (coarse ventricular fibrillation, rapid ventricular tachycardia) and high specificity (non-shockable rhythms, including supraventricular tachycardia). A pediatric-based AED can detect shockable rhythms correctly, making it safe and exceptionally effective for children. [Copyright &y& Elsevier]