Utilidad diagnóstica de los electrogramas almacenados por el desfibrilador automático implantable

The electrograms stored by present-day implantable cardioverter-defibrillators (ICDs) enable clinicians to review the electrical changes that occur during events leading to device discharge and to evaluate the effects of the therapy administered. In most patients, this information enables the type of arrhythmia responsible for ICD activation to be accurately determined and, consequently, treatment to be optimized. Nevertheless, additional discriminative criteria are needed to enable the etiology of the episodes detected by the device to be classified yet more accurately. This article considers: a) the basic principles for classifying arrhythmias on the basis of an analysis of stored intracardiac electrograms of arrhythmic episodes; b) the usefulness of intracardiac electrogram analysis for treating patients with ventricular arrhythmias; c) the main limitations of the classification methods currently used; and, finally, d) the evidence available on the usefulness of new classification methods.