PO-02-087 NOVEL DEVICE-BASED DISCRIMINATORS IMPROVE DIFFERENTIATION OF POLYMORPHIC VT AND VF FROM MONOMORPHIC VT IN IMPLANTABLE CARDIAC DEFIBRILLATORS

ICDs rely upon programmable rate cutoffs to direct therapy delivery. Studies showing reduced mortality when high voltage (HVT) is avoided have led programming that promotes longer detection times and higher rates. However, such can also result in delayed for hemodynamically compromising polymorphic VT (PVT) or ventricular fibrillation (VF). We aim characterize tachyarrhythmia (VTA) features develop an algorithm improve discriminating power PVT/VF versus MVT enable tailored HVT. Dataset of de-identified episodes VTA from Abbott’s Merlin.net database were adjudicated as by three blinded Electrophysiologists independently. Cohen’s Kappa score measured inter-observer agreement. Four discriminators near-field channel during evaluated. 1) Mean cycle length (CL), 2) Rate-adjusted interval instability (RAII), defined range RR intervals divided mean CL, 3) peak amplitude, 4) amplitude instability, difference consecutive amplitudes. Receiver operating characteristic (ROC) curves area under curve (AUC) scores computed each discriminator. The predictive performance was assessed via multiple linear regression. Eighty (34 46 MVT) with excellent agreement (kappa ≥ 0.9). All four showed significant between groups had good ability classify (Table 1). Multiple regression all reliably predicted (each p<0.001). combination 4 best (sum squared errors =3.7 vs 12.0 CL alone). An discrimination incorporating individual achieved diagnostic sensitivity 94% specificity 96%. Tachycardia cutoff sub-optimally differentiates MVT. Discriminators based on variability magnitude amplitudes accurately identifies PVT/VF. Incorporating these a device-based could tailor ensuring prompt treatment the highest risk arrhythmias while safely extending time reduce unnecessary HVT.Tabled 1Table 1 - Characteristics groupsDiscriminatorPVT/VFMVTp-valueROC-AUCMean (ms)314±43423±83<0.0010.87Rate-adjusted (ms/ms)0.52±0.380.08±0.08<0.0010.90Mean (mV)3.1±1.85.8±1.3<0.0010.89Mean (mV)0.63±0.460.16±0.34<0.0010.87 Open table new tab