Head‐To‐Head Comparison of Arrhythmia Discrimination Performance of Subcutaneous and Transvenous ICD Arrhythmia Detection Algorithms: The START Study

Abstract

Appropriate ventricular arrhythmia detection is excellent for all ICD systems evaluated; however, specificity of supraventricular arrhythmia discrimination by the S-ICD system is better than discrimination by 2 of 3 TV systems.

2015 HRS/EHRA/APHRS/SOLAECE expert consensus statement on optimal implantable cardioverter-defibrillator programming and testing

“…When programmed to include a conditional shock zone, the S-ICD VT detection algorithm has been demonstrated to be more effective than transvenous ICD systems programmed at nominal settings to prevent the detection of induced supraventricular arrhythmias [153]. Furthermore, in the clinical evaluation of the conditional shock zone, the S-ICD system was strongly associated with a reduction in inappropriate shocks from supraventricular arrhythmias and did not result in prolongation of detection times or increased syncope [154].…”

Lead or be led: an update on leadless cardiac devices for general physicians

“…Around 8% of S-ICD patients receive inappropriate therapy and this is mainly due to oversensing. 11 This rate is comparable to present TV-ICD systems and can be substantially and safely reduced with appropriate device programming. 12 The S-ICD requires greater defibrillation energy (80 Joules) than a TV-ICD (35 Joules).…”

A Case of Inappropriate Therapies for Atrial Flutter From a Subcutaneous ICD

“…The START study [2] compared the ability of S-ICD with single chamber and dual chamber transvenous ICD to sense arrhythmias induced during programmed electrophysiological testing in 64 patients. This demonstrated that the S-ICD specificity in discriminating supraventricular arrhythmias was superior to transvenous systems (98.0% vs. 68.0% p<0.001).…”