A comparison of four new time-domain techniques for discriminating monomorphic ventricular tachycardia from sinus rhythm using ventricular waveform morphology

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Abstract
Electrical management of intractable tachycardia via implantable antitachycardia devices has become a major form of therapy. Newly advanced methods of ventricular tachycardia detection propose examination of changes in intraventricular electrogram morphology in addition to or in combination with earlier rate-based detection algorithms. Unfortunately, most of the proposed morphology analysis techniques have computational demands beyond the capabilities of present devices or may be adversely affected by amplitude and baseline fluctuations of the intraventricular electrogram. We have designed four new computationally efficient time-domain algorithms for distinguishing ventricular electrograms during monomorphic ventricular tachycardia (VT) from those during sinus rhythm using direct analysis of the ventricular electrogram morphology. All four techniques are independent of amplitude fluctuations and three of the four are independent of baseline changes. These new techniques were compared to correlation waveform analysis, a previously proposed method for distinction of VT from sinus rhythm. Evaluation of these four new algorithms was performed on data from 19 consecutive patients with 31 distinct monomorphic ventricular tachycardia morphologies. Three of the algorithms performed as well or better than correlation waveform analysis but with one-tenth to one-half the computational demands.