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Oesterle A, Dhruva SS, Pellegrini CN, Liem B, Raitt MH. Ventricular arrhythmia detection for contemporary Biotronik and Abbott implantable cardioverter defibrillators with markedly prolonged detection in Biotronik devices. J Interv Card Electrophysiol 2023; 66:1679-1691. [PMID: 36737506 DOI: 10.1007/s10840-023-01498-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 01/27/2023] [Indexed: 02/05/2023]
Abstract
BACKGROUND Implantable cardioverter defibrillators (ICDs) are typically programed with both ventricular tachycardia (VT) and ventricular fibrillation (VF) treatment zones. Biotronik and Abbott ICDs do not increment the VT counter when the tachycardia accelerates to the VF zone, which could result in a prolonged delay in tachycardia detection. METHODS Patients with Biotronik and Abbott ICDs receiving care at Veterans Affairs facilities in Northern California were identified. Patient information and device tracings for patients with any ICD therapies were examined to assess for possible delayed tachycardia detection. RESULTS Among 52 patients with Biotronik ICDs, 8 (15%) experienced appropriate ICD therapy over a median follow-up of 29 months. Among 68 patients with Abbott ICDs, 26 (38%) experienced appropriate ICD therapy over a median follow-up of 83 months. Three of the patients with Biotronik ICDs who received appropriate therapy experienced a delay in VT/VF detection due to the tachycardia rate oscillating between the VT and VF treatment zones (longest 31.2 s on detection), compared with four of the patients with Abbott ICDs (longest 4.1 s on the detection and 8 s on redetect). One of the patients with a Biotronik ICD experienced recurrent syncope associated with delayed detection and another died on the day of delayed detection. One of the patients with an Abbott ICD experienced syncope. CONCLUSIONS Because contemporary Biotronik and Abbott ICDs freeze the VT counters when tachycardia is in the VF zone, ICD therapies can be markedly delayed when the tachycardia oscillates between the VT and VF zone.
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Affiliation(s)
- Adam Oesterle
- Division of Cardiology, Department of Medicine, University of California San Francisco - Veterans Affairs San Francisco Health Care System, 4150 Clement Street, Building 203, Room 2A-25, San Francisco, CA, 94121, USA.
| | - Sanket S Dhruva
- Division of Cardiology, Department of Medicine, University of California San Francisco - Veterans Affairs San Francisco Health Care System, 4150 Clement Street, Building 203, Room 2A-25, San Francisco, CA, 94121, USA
| | - Cara N Pellegrini
- Division of Cardiology, Department of Medicine, University of California San Francisco - Veterans Affairs San Francisco Health Care System, 4150 Clement Street, Building 203, Room 2A-25, San Francisco, CA, 94121, USA
| | - Bing Liem
- Division of Cardiology, Department of Medicine, University of California San Francisco - Veterans Affairs San Francisco Health Care System, 4150 Clement Street, Building 203, Room 2A-25, San Francisco, CA, 94121, USA
| | - Merritt H Raitt
- Division of Cardiology, Veterans Affairs Portland Health Care System, Portland, OR, USA
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Hindricks G, Theuns DA, Bar-Lev D, Anguera I, Ayala Paredes FA, Arnold M, Geller JC, Merkely B, Dyrda KM, Perings C, Maglia G, Ploux S, Meyhöfer J, Blomström-Lundqvist C, Karjalainen P, Liang Y, Diemberger I, Wranicz JK, Barr C, Quartieri F, Timmel T, Bollmann A. Ability to remotely monitor atrial high-rate episodes using a single-chamber implantable cardioverter-defibrillator with a floating atrial sensing dipole. Europace 2023; 25:euad061. [PMID: 37038759 PMCID: PMC10227664 DOI: 10.1093/europace/euad061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 12/06/2022] [Indexed: 04/12/2023] Open
Abstract
AIMS To allow timely initiation of anticoagulation therapy for the prevention of stroke, the European guidelines on atrial fibrillation (AF) recommend remote monitoring (RM) of device-detected atrial high-rate episodes (AHREs) and progression of arrhythmia duration along pre-specified strata (6 min…<1 h, 1 h…<24 h, ≥ 24 h). We used the MATRIX registry data to assess the capability of a single-lead implantable cardioverter-defibrillator (ICD) with atrial sensing dipole (DX ICD system) to follow this recommendation in patients with standard indication for single-chamber ICD. METHODS AND RESULTS In 1841 DX ICD patients with daily automatic RM transmissions, electrograms of first device-detected AHREs per patient in each duration stratum were adjudicated, and the corresponding positive predictive values (PPVs) for the detections to be true atrial arrhythmia were calculated. Moreover, the incidence and progression of new-onset AF was assessed in 1451 patients with no AF history. A total of 610 AHREs ≥6 min were adjudicated. The PPV was 95.1% (271 of 285) for episodes 6min…<1 h, 99.6% (253/254) for episodes 1 h…<24 h, 100% (71/71) for episodes ≥24 h, or 97.5% for all episodes (595/610). The incidence of new-onset AF was 8.2% (119/1451), and in 31.1% of them (37/119), new-onset AF progressed to a higher duration stratum. Nearly 80% of new-onset AF patients had high CHA2DS2-VASc stroke risk, and 70% were not on anticoagulation therapy. Age was the only significant predictor of new-onset AF. CONCLUSION A 99.7% detection accuracy for AHRE ≥1 h in patients with DX ICD systems in combination with daily RM allows a reliable guideline-recommended screening for subclinical AF and monitoring of AF-duration progression.
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Affiliation(s)
- Gerhard Hindricks
- Department of Electrophysiology, Heart Centre Leipzig and Leipzig Heart Institute, Strümpellstrasse 39, 04289 Leipzig, Germany
| | - Dominic A Theuns
- Erasmus University Medical Center,‘s-Gravendijkwal 230, 3015 GD Rotterdam, TheNetherlands
| | - David Bar-Lev
- Chaim Sheba Medical Center,52621 Tel Hashomer, Israel
| | - Ignasi Anguera
- Arrhythmia Unit, Heart Diseases Institute, Bellvitge Biomedical Research Institute (IDIBELL), Bellvitge University Hospital, Feixa Llarga, 08907 L'Hospitalet, Barcelona, Spain
| | | | - Martin Arnold
- Department of Cardiology, Friedrich-Alexander-Universität Erlangen-Nuremberg, Ulmenweg 18, 91054 Erlangen, Germany
| | - J Christoph Geller
- Zentralklinik Bad Berka GmbH,Robert-Koch-Allee 9, 99437 Bad Berka, Germany
| | - Béla Merkely
- Semmelweis Medical University, Városmajorutca 68, 1122 Budapest, Hungary
| | - Katia Marjolaine Dyrda
- Montreal Heart Institute affiliated with Université de Montréal, 5000, rue Belanger, H1T 1C8 Montréal, Québec, Canada
| | | | - Giampiero Maglia
- Azienda Ospedaliera Pugliese Ciaccio, Via Vinicio Cortese 25, 88100 Catanzaro, Italia
| | - Sylvain Ploux
- Hôpital Haut Lévêque (CHU), 1 avenue de Magellan, 33600 Pessac Cedex, France
| | - Jürgen Meyhöfer
- Maria Heimsuchung—Caritas-Klinik Pankow,Breite Str. 46/47, 13187 Berlin, Germany
| | - Carina Blomström-Lundqvist
- Department of Cardiology, School of Medical Sciences, Faculty of Medicine and Health, Örebro University, SE-701 82 Örebro, Sweden
- Department of Medical Science and Cardiology, Uppsala University, S-751 85 Uppsala, Sweden
| | - Pasi Karjalainen
- Satakunta Central Hospital, Sydänyksikkö, Sairaalantie 3, 28500 Pori, Finland
| | - Yanchun Liang
- General Hospital of Northern Theater Command, No. 83 Wenhua Road, Shenhe District, 110016 Shenyang, China
| | - Igor Diemberger
- Department of Experimental, Diagnostic and Specialty Medicine, Institute of Cardiology, University of Bologna, Via Massarenti 9, 40138 Bologna, Italia
| | - Jerzy Krzysztof Wranicz
- Department of Electrocardiology, Medical University of Lodz, Ul. Pomorska 251, 92-213 Łódź, Poland
| | - Craig Barr
- Russells Hall Hospital, Pensett Road, DY1 2HQ Dudley, UK
| | - Fabio Quartieri
- Arcispedale Santa Maria Nuova, Viale Risorgimento 80, 42123 Reggio Emilia, Italia
| | - Tobias Timmel
- Biotronik SE & Co. KG,Woermannkehre 1, 12359 Berlin, Germany
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Gwag HB, Kim HR, Park SJ, Kim J, Chung TW, Choi JH, Kim JY, Park KM, On YK, Kim JS. The efficacy of single-lead implantable cardioverter-defibrillator with atrial sensing dipole to detect atrial fibrillation and to reduce inappropriate therapy according to atrial sensing ON or OFF: Rationale and design of the SMART-CONTROL study, a prospective multicenter randomized trial. Am Heart J 2022; 251:25-31. [PMID: 35568193 DOI: 10.1016/j.ahj.2022.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 04/30/2022] [Accepted: 05/04/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Few studies have compared the efficacy of single-lead implantable cardioverter-defibrillator (ICD) with atrial sensing dipole (VDD-ICD) and conventional single-chamber ICD from the aspect of atrial fibrillation (AF) detection or inappropriate ICD therapy reduction. In the SMART-CONTROL trial (NCT03932604), we primarily aim to investigate whether the atrial sensing capability of VDD-ICD is useful in AF detection and inappropriate therapy reduction by randomly activating or deactivating the atrial sensing function. METHODS AND DESIGN This study was designed as a prospective, multicenter, open-label, randomized trial to enroll 640 patients with no history of clinical AF or rhythm control for AF within 1 year who were undergoing the implantation of VDD-ICD system. Patients are assigned randomly to atrial sensing "ON" or "OFF" group, with crossover allowed during follow-up. The coprimary outcomes are the incidence of AF detection and inappropriate ICD therapy over a 2-year follow-up period. The secondary outcomes include non-AF atrial tachyarrhythmia, ventricular tachyarrhythmia with or without ICD therapy, thromboembolic events, bleeding, heart failure hospitalization, mortality, a composite of adverse cardiovascular events, and long-term atrial sensing stability or variability. CONCLUSION We expect that this trial can evaluate the efficacy of a single-lead ICD system on various clinical outcomes including AF detection and inappropriate therapy reduction, and ultimately provide guidance to selection of ICD system.
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Affiliation(s)
- Hye Bin Gwag
- Division of Cardiology, Department of Internal Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea
| | - Hye Ree Kim
- Division of Cardiology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Seung-Jung Park
- Division of Cardiology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
| | - Juwon Kim
- Division of Cardiology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Tae Wan Chung
- Division of Cardiology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Ji-Hoon Choi
- Division of Cardiology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Ju Youn Kim
- Division of Cardiology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Kyoung-Min Park
- Division of Cardiology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Young Keun On
- Division of Cardiology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - June Soo Kim
- Division of Cardiology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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Pung X, Hong DZ, Ho TY, Shen X, Tan PT, Yeo C, Tan VH. The utilization of atrial sensing dipole in single lead implantable cardioverter defibrillator for detection of new-onset atrial high-rate episodes or subclinical atrial fibrillation: A systematic review and meta-analysis. J Arrhythm 2022; 38:177-186. [PMID: 35387136 PMCID: PMC8977580 DOI: 10.1002/joa3.12675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 12/14/2021] [Accepted: 01/03/2022] [Indexed: 11/10/2022] Open
Abstract
This meta-analysis aims to evaluate the performance of atrial sensing dipole in single lead implantable cardioverter defibrillator (VDD-ICD) recipients in particular diagnosing new-onset atrial high-rate episodes (AHREs) defined as rate threshold of 200 beats per minute, or subclinical atrial fibrillation (SCAF) defined as device-detected AF without symptoms. We comprehensively searched PubMed, Embase, and ClinicalTrials.gov. Studies comparing contemporary single- and dual-chamber ICD (VVI-/DDD-ICD) versus VDD-ICD were included. Restricted maximum likelihood method for random effect model and Mantel-Haenszel method for fixed effect model were used to estimate the effect size of new-onset AHREs, or SCAF detection in each group. Three prospective studies were identified and total of 991 participants were included. There were 330 (33.3%) in VDD-ICD and 661 (66.7%) in VVI-/DDD-ICD. Most (78%) participants were men. Median follow-up was from 365 days to 847 days. VDD-ICD has a higher likelihood of detecting AHREs or SCAF as compared to VVI-/DDD-ICD [(OR random effect : 2.6; 95% CI: 1.2, 5.8; p = .018); I-squared = 67.8%, p = .019]. This difference was more apparently seen in the comparison between VDD-ICD and VVI-ICD [(OR random effect: 3.8; 95% CI: 2.1, 6.6, p < .001), I-squared = 0.0%, p = .518]. The result is same as fixed effect. Rate of AHREs detection observed in VDD-ICD was not statistically different when compared to the only group with DDD-ICD from SENSE trial. In conclusion, this meta-analysis reveals that the use of floating atrial sensing dipole in VDD-ICD increases the detection of new-onset AHREs or SCAF when compared to VVI-ICD, with similar atrial sensing performance to DDD-ICD.
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Affiliation(s)
- Xuanming Pung
- Department of CardiologyChangi General HospitalSingapore CitySingapore
| | - Daniel Zhihao Hong
- Yong Loo Lin School of MedicineNational University of SingaporeSingapore CitySingapore
| | - Tzyy Yeou Ho
- Yong Loo Lin School of MedicineNational University of SingaporeSingapore CitySingapore
| | - Xiayan Shen
- Department of CardiologyChangi General HospitalSingapore CitySingapore
| | - Pei Ting Tan
- Health Services ResearchChangi General HospitalSingapore CitySingapore
| | - Colin Yeo
- Department of CardiologyChangi General HospitalSingapore CitySingapore
| | - Vern Hsen Tan
- Department of CardiologyChangi General HospitalSingapore CitySingapore
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Long-term evaluation of sensing variability of a floating atrial dipole in a single‑lead defibrillator: The mechanistic basis of long-term stability of amplified atrial electrogram. Int J Cardiol 2021; 336:67-72. [PMID: 33992702 DOI: 10.1016/j.ijcard.2021.05.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 04/25/2021] [Accepted: 05/10/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND A single‑lead implantable cardioverter-defibrillator (ICD) with a floating atrial dipole has been developed to enhance the diagnostic capability of atrial arrhythmias and to facilitate adjudication of arrhythmic events without the additional effort required for atrial lead insertion. However, there have been concerns about the long-term reliability of atrial sensing. METHODS We enrolled patients with the single-chamber ICD with atrial-sensing electrodes from 4 tertiary university hospitals in Korea. Minimal, maximal, and mean P wave amplitudes were collected at 3-6 months, 6-12 months, and 12-24 months after implantation. The difference between the minimal and maximal sensing amplitudes was calculated as an indicator of the variability of atrial sensing, while the atrial sensing stability was assessed using the mean amplitude. RESULTS A total of 86 patients were included for analysis. The variability of atrial sensing amplitudes significantly decreased at 12-24 months compared to 3-6 months (p = 0.01), while mean atrial amplitudes were stable throughout the mean follow-up duration of 17.4 months. Nine patients (10.5%) experienced inappropriate ICD therapy mostly due to misclassification of supraventricular tachycardia. CONCLUSIONS Under the hypothesis that sensing stability can be guaranteed as the variability decreases with time, we suggest that the concern about long-term sensing stability of a floating dipole can be abated with an ICD that has been implanted for over 2 years.
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Vamos M, Nemeth M, Balazs T, Zima E, Duray GZ. Rationale and feasibility of the atrioventricular single-lead ICD systems with a floating atrial dipole (DX) in clinical practice. Trends Cardiovasc Med 2021; 32:84-89. [PMID: 33482321 DOI: 10.1016/j.tcm.2021.01.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 01/12/2021] [Accepted: 01/14/2021] [Indexed: 01/30/2023]
Abstract
Cardiac implantable electronic devices establish proper therapy for the prevention of sudden cardiac death, significantly reducing the morbidity and mortality of patients with arrhythmias and heart failure. It is well-known that the number of electrodes increases the risk of complications. To preserve the benefit of atrial sensing without the need to implant an additional lead, a single-lead ICD system with a floating atrial dipole (DX ICD lead) has been developed. Besides all of the potential benefits, the necessity of a reliable and stable atrial sensing via the floating dipole could be the main concern against the use of this lead type. In the current generation of DX devices, the specially filtered atrial signal seems to be high enough and stable over time, which is crucial in the early detection of atrial arrhythmias, discrimination between different forms of tachycardias in order to prevent inappropriate ICD therapy, and achieving an optimal atrioventricular and interventricular synchrony in patients with a two-lead CRT-DX system. The present review summarizes the benefits and potential drawbacks of the DX ICD systems based on the available literature, furthermore, proposes an evidence-based algorithm of ICD type selection.
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Affiliation(s)
- Mate Vamos
- Department of Internal Medicine, Cardiac Electrophysiology Division, University of Szeged, Semmelweis u. 8., 6725 Szeged, Szeged, Hungary.
| | | | | | - Endre Zima
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Gabor Zoltan Duray
- Department of Cardiology, Medical Centre, Hungarian Defense Forces, Budapest, Hungary
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7
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Baalman SWE, Mittal S, Boersma LVA, Perschbacher D, Brisben AJ, Mahajan D, de Groot JR, Knops RE. Real-world performance of the atrial fibrillation monitor in patients with a subcutaneous ICD. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2020; 43:1467-1475. [PMID: 32662101 PMCID: PMC7754353 DOI: 10.1111/pace.14010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 07/09/2020] [Accepted: 07/12/2020] [Indexed: 12/19/2022]
Abstract
Introduction The third‐generation subcutaneous implantable cardioverter‐defibrillator (S‐ICD) (EMBLEM™ A219, Boston Scientific) contains a new diagnostic tool to detect atrial fibrillation (AF) in S‐ICD patients, without the use of an intracardiac lead. This is the first study to evaluate the performance of the S‐ICD AF monitor (AFM). Methods The AFM algorithm analyzes a subcutaneous signal for the presence of AF, similar to the signals collected by implantable and wearable diagnostic devices. The AFM algorithm combines heart rate (HR) scatter analysis with an HR histogram. The algorithm was tested against publicly available electrocardiogram databases (simulated performance). Real‐world performance of the algorithm was evaluated by using the S‐ICD LATITUDE remote monitoring (RM) database. Results The simulated performance of the AFM algorithm resulted in a sensitivity of 95.0%, specificity of 100.0%, and positive predictive value (PPV) of 100.0%. To evaluate the real‐world performance of the AFM, 7744 S‐ICD devices were followed for up to 30 months by RM, whereof 99.5% had the AFM enabled. A total of 387 AF episodes were randomly chosen for adjudication, resulting in a PPV of 67.7%. The main cause of misclassification was atrial and ventricular ectopy. Conclusion The AFM exhibited a very high sensitivity and specificity in a simulated setting, designed to maximize PPV in order to minimize the clinical burden of reviewing falsely detected AF events. The real‐world performance of the AFM, enabled in 99.5% of S‐ICD patients, is a PPV of 67.7%.
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Affiliation(s)
- Sarah W E Baalman
- Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Suneet Mittal
- The Snyder Center for Comprehensive Atrial Fibrillation at the Valley Health System, Ridgewood, New Jersey
| | - Lucas V A Boersma
- Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands.,St. Antonius Hospital, Nieuwegein, The Netherlands
| | | | | | | | - Joris R de Groot
- Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Reinoud E Knops
- Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
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Mittal S. The VDD ICD lead: Friend or Foe? Indian Pacing Electrophysiol J 2020; 20:135-136. [PMID: 32325239 PMCID: PMC7384363 DOI: 10.1016/j.ipej.2020.04.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 04/13/2020] [Indexed: 12/19/2022] Open
Affiliation(s)
- Suneet Mittal
- From the Snyder Center for Comprehensive Atrial Fibrillation at the Valley Health System, Ridgewood, NJ, USA.
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The efficacy of the Linox Smart DX ICD lead from a single center experience. Indian Pacing Electrophysiol J 2019; 20:137-140. [PMID: 31862483 PMCID: PMC7384368 DOI: 10.1016/j.ipej.2019.12.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 12/15/2019] [Indexed: 11/30/2022] Open
Abstract
Purpose The Biotronik LinoxSmart DX implanted cardioverter defibrillator (ICD) lead is a novel VDD lead with the advantage of integrated atrial sensing dipole combined with a special augmentation and filtering mechanisms. We sought to determine the efficacy of the Biotronik LinoxSmart DX ICD lead. Methods Non-randomized consecutive patients implanted with Biotronik LinoxSmart DX lead at Sheba Medical Center were included in this study. Electrical parameters and arrhythmic events were recorded during follow up of one year. Results Seventy-three patients (69 males (94.5%), mean age 61 ± 12 years) were included. All patients were successfully implanted with a Biotronic VR-T DX device and LinoxSmart DX ICD lead (DX-17 in 37% and DX-15 in 63% patients). Mean P wave amplitude at time of implantation was 3.66 ± 2.9 mV and improved significantly throughout the follow-up (5.29 ± 4.39 mV, p = 0.009). Appropriate atrial sensing (defined as P wave amplitude of ≥0.8 mV) rate of 100% at implantation significantly decreased to 89% (p = 0.015) at 12 months. Three out of 67 (4.5%) patients without a known history of atrial fibrillation had documented new onset paroxysmal atrial fibrillation. Appropriate shocks occurred in 4 (5.5%) patients. One patient with atrial sensing less than 0.4 mV had inappropriate shock. Conclusions Among patients implanted with the Biotronik LinoxSmart DX ICD lead in our single center, appropriate atrial sensing rate decreased over 12 months. Larger studies are needed to evaluate the reliability of long term appropriate atrial sensing.
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Thomas G, Choi DY, Doppalapudi H, Richards M, Iwai S, Daoud EG, Houmsse M, Kanagasundram AN, Mainigi SK, Lubitz SA, Cheung JW. Subclinical atrial fibrillation detection with a floating atrial sensing dipole in single lead implantable cardioverter-defibrillator systems: Results of the SENSE trial. J Cardiovasc Electrophysiol 2019; 30:1994-2001. [PMID: 31328298 PMCID: PMC6852241 DOI: 10.1111/jce.14081] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 06/07/2019] [Accepted: 07/04/2019] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Subclinical atrial fibrillation (AF), in the form of cardiac implantable device-detected atrial high rate episodes (AHREs), has been associated with increased thromboembolism. An implantable cardioverter-defibrillator (ICD) lead with a floating atrial dipole may permit a single lead (DX) ICD system to detect AHREs. We sought to assess the utility of the DX ICD system for subclinical AF detection in patients, with a prospective multicenter, cohort-controlled trial. METHODS AND RESULTS One hundred fifty patients without prior history of AF (age 59 ± 13 years; 108 [72%] male) were enrolled into the DX cohort and implanted with a Biotronik DX ICD system at eight centers. Age-, sex-, and left ventricular ejection fraction-matched single- and dual-chamber ICD cohorts were derived from a Cornell database and from the IMPACT trial, respectively. The primary endpoint were AHRE detection at 12 months. During median 12 months follow-up, AHREs were detected in 19 (13%) patients in the DX, 8 (5.3%) in the single-chamber, and 19 (13%) in the dual-chamber cohorts. The rate of AHRE detection was significantly higher in the DX cohort compared to the single-chamber cohort (P = .026), but not significantly different compared to the dual-chamber cohort. There were no inappropriate ICD therapies in the DX cohort. At 12 months, only 3.0% of patients in the DX cohort had sensed atrial amplitudes less than 1.0 mV. CONCLUSION Use of a DX ICD lead allows subclinical AF detection with a single lead DX system that is superior to that of a conventional single-chamber ICD system.
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Affiliation(s)
- George Thomas
- Division of Cardiology, Weill Cornell Medicine, NewYork-Presbyterian Hospital, New York, New York
| | - Daniel Y Choi
- Division of Cardiology, Weill Cornell Medicine, NewYork-Presbyterian Hospital, New York, New York
| | - Harish Doppalapudi
- Division of Cardiology, University of Alabama at Birmingham, Birmingham, Alabama
| | | | - Sei Iwai
- Division of Cardiology, Westchester Medical Center, Valhalla, New York
| | - Emile G Daoud
- Division of Cardiovascular Medicine, The Ohio State University Medical Center, Columbus, Ohio
| | - Mahmoud Houmsse
- Division of Cardiovascular Medicine, The Ohio State University Medical Center, Columbus, Ohio
| | | | - Sumeet K Mainigi
- Department of Cardiology and Electrophysiology, Albert Einstein Medical Center, Philadelphia, Pennsylvania
| | - Steven A Lubitz
- Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Jim W Cheung
- Division of Cardiology, Weill Cornell Medicine, NewYork-Presbyterian Hospital, New York, New York
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MILAN DAVID, KLEIN HELMUT, GIMBEL JROD, KNILANS TIMOTHY, MIRRO MICHAEL, ZIRILLE FRANCIS. Considering the Need to Expand the Indications for Wearable Defibrillator Therapy. J Innov Card Rhythm Manag 2019; 10:3751-3760. [PMID: 32494421 PMCID: PMC7252810 DOI: 10.19102/icrm.2019.100707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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12
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Cost Saving Potential of an Early Detection of Atrial Fibrillation in Patients after ICD Implantation. BIOMED RESEARCH INTERNATIONAL 2018; 2018:3417643. [PMID: 30186856 PMCID: PMC6112263 DOI: 10.1155/2018/3417643] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Revised: 06/28/2018] [Accepted: 07/11/2018] [Indexed: 12/15/2022]
Abstract
Atrial fibrillation (AF) is a relevant comorbidity in recipients of implantable cardioverter-defibrillators (ICD). Latest generation single-chamber ICD allow the additional sensing of atrial tachyarrhythmias and, therefore, contribute to the early detection and treatment of AF, potentially preventing AF-related stroke. The present study aimed to measure the impact on patient-related costs of this new ICD compared to conventional ICD. A Markov model was developed to simulate the long-term incidence of stroke in patients treated with a single-chamber ICD with or without atrial sensing capabilities. The median annual cost per patient and its difference, the number of strokes avoided, and the cost per stroke avoided were estimated. During a 9-year horizon, the costs for the ICD and stroke treatment were €570 per patient-year for an ICD with atrial sensing capabilities and €491 per patient-year for a conventional ICD. Per 1,000 patients, 4.6 strokes per year are assumed to be avoided by the new device. Higher CHA2DS2-VASc scores are associated with higher numbers of avoided strokes and larger potential for cost savings. Apart from clinical advantages, the use of ICD with atrial sensing capabilities may reduce the incidence of stroke and, in high-risk patients, may also contribute to reduce overall health care costs.
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Verma KP, Adam D. An unusual source of electromagnetic interference. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2018; 41:1381-1383. [DOI: 10.1111/pace.13418] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Accepted: 06/11/2018] [Indexed: 01/29/2023]
Affiliation(s)
| | - David Adam
- Monash Heart; Monash Health; VIC Australia
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Torbey E, Love CJ. Failure to shock: What is the mechanism? PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2018; 41:669-671. [DOI: 10.1111/pace.13322] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Revised: 02/28/2018] [Accepted: 03/04/2018] [Indexed: 11/27/2022]
Affiliation(s)
- Estelle Torbey
- Electrophysiology Department, Warren Alpert Medical School, Rhode Island Hospital; Brown University; Providence RI USA
| | - Charles J. Love
- Cardiac Rhythm Device Services; Johns Hopkins Hospital; Baltimore MD USA
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Sticherling C, Müller D, Schaer BA, Krüger S, Kolb C. Atrial electrogram quality in single-pass defibrillator leads with floating atrial bipole in patients with permanent atrial fibrillation and cardiac resynchronization therapy. Indian Pacing Electrophysiol J 2018; 18:140-145. [PMID: 29596906 PMCID: PMC6090003 DOI: 10.1016/j.ipej.2018.03.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Revised: 02/07/2018] [Accepted: 03/22/2018] [Indexed: 11/24/2022] Open
Abstract
Many patients receiving cardiac resynchronization therapy (CRT) suffer from permanent atrial fibrillation (AF). Knowledge of the atrial rhythm is important to direct pharmacological or interventional treatment as well as maintaining AV-synchronous biventricular pacing if sinus rhythm can be restored. A single pass single-coil defibrillator lead with a floating atrial bipole has been shown to obtain reliable information about the atrial rhythm but has never been employed in a CRT-system. The purpose of this study was to assess the feasibility of implanting a single coil right ventricular ICD lead with a floating atrial bipole and the signal quality of atrial electrograms (AEGM) in CRT-defibrillator recipients with permanent AF. Methods and results Seventeen patients (16 males, mean age 73 ± 6 years, mean EF 25 ± 5%) with permanent AF and an indication for CRT-defibrillator placement were implanted with a designated CRT-D system comprising a single pass defibrillator lead with a atrial floating bipole. They were followed-up for 103 ± 22 days using remote monitoring for AEGM transmission. All patients had at last one AEGM suitable for atrial rhythm diagnosis and of 100 AEGM 99% were suitable for visual atrial rhythm assessment. Four patients were discharged in sinus rhythm and one reverted to AF during follow-up. Conclusion Atrial electrograms retrieved from a single-pass defibrillator lead with a floating atrial bipole can be reliably used for atrial rhythm diagnosis in CRT recipients with permanent AF. Hence, a single pass ventricular defibrillator lead with a floating bipole can be considered in this population.
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Affiliation(s)
| | - Dirk Müller
- Herz- und Gefässzentrum Bad Bevensen, Germany
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Safak E, D´Ancona G, Kaplan H, Caglayan E, Kische S, Öner A, Ince H, Ortak J. New generation cardioverter-defibrillator lead with a floating atrial sensing dipole: Long-term performance. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2018; 41:128-135. [DOI: 10.1111/pace.13256] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Revised: 11/08/2017] [Accepted: 12/03/2017] [Indexed: 12/14/2022]
Affiliation(s)
- Erdal Safak
- Department of Cardiology, Vivantes Klinikum im Friedrichshain und Am Urban, Berlin; Germany and Rostock University Medical Center; Rostock Germany
| | - Giuseppe D´Ancona
- Department of Cardiology, Vivantes Klinikum im Friedrichshain und Am Urban, Berlin; Germany and Rostock University Medical Center; Rostock Germany
| | - Hilmi Kaplan
- Department of Cardiology, Vivantes Klinikum im Friedrichshain und Am Urban, Berlin; Germany and Rostock University Medical Center; Rostock Germany
| | - Evren Caglayan
- Department of Cardiology, Vivantes Klinikum im Friedrichshain und Am Urban, Berlin; Germany and Rostock University Medical Center; Rostock Germany
| | - Stephan Kische
- Department of Cardiology, Vivantes Klinikum im Friedrichshain und Am Urban, Berlin; Germany and Rostock University Medical Center; Rostock Germany
| | - Alper Öner
- Department of Cardiology, Vivantes Klinikum im Friedrichshain und Am Urban, Berlin; Germany and Rostock University Medical Center; Rostock Germany
| | - Hüseyin Ince
- Department of Cardiology, Vivantes Klinikum im Friedrichshain und Am Urban, Berlin; Germany and Rostock University Medical Center; Rostock Germany
| | - Jasmin Ortak
- Department of Cardiology, Vivantes Klinikum im Friedrichshain und Am Urban, Berlin; Germany and Rostock University Medical Center; Rostock Germany
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Biffi M, Massaro G, Candelora A, Angeletti A, Valzania C, Martignani C, Grassini D, Diemberger I, Ziacchi M. Less is more: Can we achieve cardiac resynchronization with 2 leads only? Int J Cardiol 2017; 249:184-190. [DOI: 10.1016/j.ijcard.2017.09.189] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Revised: 08/17/2017] [Accepted: 09/22/2017] [Indexed: 10/18/2022]
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The Dx-AF study: a prospective, multicenter, randomized controlled trial comparing VDD-ICD to VVI-ICD in detecting sub-clinical atrial fibrillation in defibrillator patients. J Interv Card Electrophysiol 2017; 50:57-63. [DOI: 10.1007/s10840-017-0276-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Accepted: 07/17/2017] [Indexed: 12/19/2022]
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MICHALAK MARCIN, CACKO ANDRZEJ, GRABOWSKI MARCIN. How to Achieve Good Atrial Sensing in DX ICDs? Pacing Clin Electrophysiol 2017; 40:457. [DOI: 10.1111/pace.13011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Accepted: 12/04/2016] [Indexed: 11/29/2022]
Affiliation(s)
- MARCIN MICHALAK
- 1st Chair and Department of Cardiology; Medical University of Warsaw; Warsaw Poland
| | - ANDRZEJ CACKO
- 1st Chair and Department of Cardiology; Medical University of Warsaw; Warsaw Poland
- Department of Medical Informatics and Telemedicine; Medical University of Warsaw; Warsaw Poland
| | - MARCIN GRABOWSKI
- 1st Chair and Department of Cardiology; Medical University of Warsaw; Warsaw Poland
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WORDEN NICOLEE, ALQASRAWI MUSAB, MAZUR ALEXANDER. Long-Term Stability and Clinical Utility of Amplified Atrial Electrograms in a Single-Lead ICD System with Floating Atrial Electrodes. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2016; 39:1327-1334. [DOI: 10.1111/pace.12967] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2016] [Revised: 10/04/2016] [Accepted: 10/09/2016] [Indexed: 12/11/2022]
Affiliation(s)
- NICOLE E. WORDEN
- Division of Cardiovascular Medicine, University of Iowa Hospitals and Clinics; University of Iowa Carver College of Medicine; Iowa City Iowa
| | - MUSAB ALQASRAWI
- Division of Cardiovascular Medicine, University of Iowa Hospitals and Clinics; University of Iowa Carver College of Medicine; Iowa City Iowa
| | - ALEXANDER MAZUR
- Division of Cardiovascular Medicine, University of Iowa Hospitals and Clinics; University of Iowa Carver College of Medicine; Iowa City Iowa
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Cardoso RN, Healy C, Viles-Gonzalez J, Coffey JO. ICD discrimination of SVT versus VT with 1:1 V-A conduction: A review of the literature. Indian Pacing Electrophysiol J 2016; 15:236-44. [PMID: 27134440 PMCID: PMC4834441 DOI: 10.1016/j.ipej.2016.02.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Inappropriate ICD shocks are associated with increased mortality. They also impair patients' quality of life, increase hospitalizations, and raise health-care costs. Nearly 80% of inappropriate ICD shocks are caused by supraventricular tachycardia. Here we report the case of a patient who received a single-lead dual-chamber sensing ICD for primary prevention of sudden cardiac death and experienced inappropriate ICD shocks. V-A time, electrogram morphology, and response to antitachycardia pacing suggested atrioventricular nodal reentry tachycardia, which was confirmed in an electrophysiology study. Inspired by this case, we performed a literature review to discuss mechanisms for discrimination of supraventricular tachycardia with 1:1 A:V relationship from ventricular tachycardia with 1:1 retrograde conduction.
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Affiliation(s)
- Rhanderson N Cardoso
- Cardiovascular Division, Department of Medicine, University of Miami, Miller School of Medicine, Miami, USA
| | - Chris Healy
- Cardiovascular Division, Department of Medicine, University of Miami, Miller School of Medicine, Miami, USA
| | - Juan Viles-Gonzalez
- Cardiovascular Division, Department of Medicine, University of Miami, Miller School of Medicine, Miami, USA
| | - James O Coffey
- Cardiovascular Division, Department of Medicine, University of Miami, Miller School of Medicine, Miami, USA
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Worden NE, Alqasrawi M, Krothapalli SM, Mazur A. "Two for the Price of One": A Single-Lead Implantable Cardioverter-Defibrillator System with a Floating Atrial Dipole. J Atr Fibrillation 2016; 8:1396. [PMID: 27909501 DOI: 10.4022/jafib.1396] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Revised: 04/06/2016] [Accepted: 04/09/2016] [Indexed: 12/28/2022]
Abstract
In patients known to be a high risk for sudden cardiac arrest, implantable cardioverter defibrillators (ICD) are a proven therapy to reduce risk of death. However, in patients without conventional indications for pacing, the optimal strategy for type of device, dual- versus single-chamber, remains debatable. The benefit of prophylactic pacing in this category of patients has never been documented. Although available atrial electrograms in a dual chamber system improve interpretation of stored arrhythmia events, allow monitoring of atrial fibrillation and may potentially reduce the risk of inappropriate shocks by enhancing automated arrhythmia discrimination, the use of dual-chamber ICDs has a number of disadvantages. The addition of an atrial lead adds complexity to implantation and extraction procedures, increases procedural cost and is associated with a higher risk of periprocedural complications. The single lead pacing system with ability to sense atrial signals via floating atrial electrodes (VDD) clinically became available in early 1980's but did not gain much popularity due to inconsistent atrial sensing and concerns about the potential need for an atrial lead if sinus node fails. Most ICD patients do not have indications for pacing at implantation and subsequent risk of symptomatic bradycardia seems to be low. The concept of atrial sensing via floating electrodes has recently been revitalized in the Biotronik DX ICD system (Biotronik, SE & Co., Berlin, Germany) aiming to provide all of the potential advantages of available atrial electrograms without the risks and incremental cost of an additional atrial lead. Compared to a traditional VDD pacing system, the DX ICD system uses an optimized (15 mm) atrial dipole spacing and improved atrial signal processing to offer more reliable atrial sensing. The initial experience with the DX system indicates that the clinically useful atrial signal amplitude in sinus rhythm remains stable over time. Future studies are needed to determine reliability of atrial sensing during tachyarrhythmias, particularly atrial fibrillation as well as clinical utility and cost-effectiveness of this technology in different populations of patients.
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Affiliation(s)
- Nicole E Worden
- Division of Cardiovascular Medicine, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Musab Alqasrawi
- Division of Cardiovascular Medicine, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Siva M Krothapalli
- Division of Cardiovascular Medicine, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Alexander Mazur
- Division of Cardiovascular Medicine, University of Iowa Hospitals and Clinics, Iowa City, Iowa
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Swerdlow CD, Asirvatham SJ, Ellenbogen KA, Friedman PA. Troubleshooting implantable cardioverter-defibrillator sensing problems II. Circ Arrhythm Electrophysiol 2015; 8:212-20. [PMID: 25691555 DOI: 10.1161/circep.114.002514] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Charles D Swerdlow
- From the Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (C.D.S.); Division of Cardiology, Mayo Clinic, Rochester, MN (S.J.A., P.A.F.); and Division of Cardiology, Virginia Commonwealth University School of Medicine, Richmond, VA (K.A.E.).
| | - Samuel J Asirvatham
- From the Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (C.D.S.); Division of Cardiology, Mayo Clinic, Rochester, MN (S.J.A., P.A.F.); and Division of Cardiology, Virginia Commonwealth University School of Medicine, Richmond, VA (K.A.E.)
| | - Kenneth A Ellenbogen
- From the Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (C.D.S.); Division of Cardiology, Mayo Clinic, Rochester, MN (S.J.A., P.A.F.); and Division of Cardiology, Virginia Commonwealth University School of Medicine, Richmond, VA (K.A.E.)
| | - Paul A Friedman
- From the Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (C.D.S.); Division of Cardiology, Mayo Clinic, Rochester, MN (S.J.A., P.A.F.); and Division of Cardiology, Virginia Commonwealth University School of Medicine, Richmond, VA (K.A.E.)
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Iori M, Giacopelli D, Quartieri F, Bottoni N, Manari A. Implantable cardioverter defibrillator system with floating atrial sensing dipole: a single-center experience. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2014; 37:1265-73. [PMID: 24809851 DOI: 10.1111/pace.12421] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2013] [Revised: 03/13/2014] [Accepted: 03/18/2014] [Indexed: 12/13/2022]
Abstract
BACKGROUND The concept of a single-lead dual-chamber implantable cardioverter defibrillator (ICD) with floating sensing atrial dipole has been proven safe and functional. We report a single-center experience with this ICD system; the major focus of the work is on the recorded atrial activation and its stability on a medium term follow-up. METHODS Thirteen patients received a DX ICD (BIOTRONIK SE & Co, Berlin, Germany) with the Linox Smart S DX(ProMRI) ICD lead; the implantation data were reported. Daily P- and R-wave sensing amplitude was collected and followed up during 200 days; their coefficient of variance (CV) was calculated. In addition, all the atrial and ventricular high-rate episodes were analyzed. RESULTS The total x-ray exposure time was 3.9 ± 1.8 minutes. The overall mean sensing was 4.2 ± 1.9 mV for P wave and 12.9 ± 4.5 mV for R wave. The CV was significantly higher for the P-wave amplitude than for the R-wave one (0.25 ± 0.11 vs 0.08 ± 0.06; P < 0.001). A total of 27 high ventricular rate episodes were recorded and correctly discriminated by the device. Fifty-six high atrial rate episodes were recorded, 49 were true arrhythmic events. CONCLUSIONS The single-lead ICD system with floating atrial dipole provides reliable atrial sensing amplitude over time. The physician, without the implantation of an additional lead, has the atrial information that may be used for the discrimination of supraventricular tachyarrhythmia/ventricular tachycardia, for the early detection of atrial fibrillation episodes and for the evaluation of changes in the patient's heart status.
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Affiliation(s)
- Matteo Iori
- Cardiologia Interventistica, Arcispedale Santa Maria Nuova, Reggio Emilia (RE), Italy
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VIJAYVERGIYA RAJESH. To the Editor. Pacing Clin Electrophysiol 2014; 37:129-30. [DOI: 10.1111/pace.12259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- RAJESH VIJAYVERGIYA
- Post Graduate Institute of Medical Education & Research; Chandigarh 160 012 India
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