A method discriminates between ventricular arrhythmia and supraventricular
arrhythmia by determining the direction of an electrical signal conducted
through the atrioventricular node. An implantable cardiac defibrillator
provides atrioventricular and ventriculoatrial pacing bursts to determine
if an arrhythmia with a 1:1 atrial to ventricular relationship is due to
ventricular tachycardia or supraventricular tachycardia. This
discrimination capability reduces the incidence of inappropriate shocks
from dual-chamber implantable cardiac defibrillators to near zero and
provides a method to differentially diagnose supraventricular tachycardia
from ventricular tachycardia.