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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] [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
Affiliation(s)
- Xuanming Pung
- Department of Cardiology Changi General Hospital Singapore City Singapore
| | - Daniel Zhihao Hong
- Yong Loo Lin School of Medicine National University of Singapore Singapore City Singapore
| | - Tzyy Yeou Ho
- Yong Loo Lin School of Medicine National University of Singapore Singapore City Singapore
| | - Xiayan Shen
- Department of Cardiology Changi General Hospital Singapore City Singapore
| | - Pei Ting Tan
- Health Services Research Changi General Hospital Singapore City Singapore
| | - Colin Yeo
- Department of Cardiology Changi General Hospital Singapore City Singapore
| | - Vern Hsen Tan
- Department of Cardiology Changi General Hospital Singapore City Singapore
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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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SAFAK ERDAL, SCHMITZ DIETMAR, KONORZA THOMAS, WENDE CHRISTIAN, DE ROS JOSEOLAGUE, SCHIRDEWAN ALEXANDER. Clinical Efficacy and Safety of an Implantable Cardioverter-Defibrillator Lead with a Floating Atrial Sensing Dipole. Pacing Clin Electrophysiol 2013; 36:952-62. [PMID: 23692262 DOI: 10.1111/pace.12171] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2012] [Revised: 03/04/2013] [Accepted: 03/12/2013] [Indexed: 11/28/2022]
Affiliation(s)
- ERDAL SAFAK
- Charité Campus Benjamin Franklin; Medical Clinic II; Berlin; Germany
| | - DIETMAR SCHMITZ
- Clinic for Cardiology and Angiology; Elisabeth Hospital; Essen; Germany
| | | | - CHRISTIAN WENDE
- Department of Cardiology; Marien Hospital; Papenburg; Germany
| | - JOSE OLAGUE DE ROS
- Department of Cardiology; Hospital University La FE Valencia; Arrhythmias Service; Spain
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Sticherling C, Zabel M, Spencker S, Meyerfeldt U, Eckardt L, Behrens S, Niehaus M. Comparison of a Novel, Single-Lead Atrial Sensing System With a Dual-Chamber Implantable Cardioverter-Defibrillator System in Patients Without Antibradycardia Pacing Indications. Circ Arrhythm Electrophysiol 2011; 4:56-63. [DOI: 10.1161/circep.110.958397] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
Supraventricular tachyarrhythmias are the main cause for inappropriate therapy by implantable cardioverter-defibrillators (ICDs). For better rhythm discrimination, an atrial electrogram is helpful and usually obtained from an additional atrial lead, even in the absence of sinus node or atrioventricular nodal disease. An A+-ICD system with integrated atrial sensing rings mounted 15 to 18 cm from the tip of an ICD lead may obviate the need to implant a separate atrial lead. The aim of the study was to compare the novel A+-ICD and a conventional dual-chamber (DR)-ICD.
Methods and Results—
Two hundred forty-nine patients with standard ICD indications but no requirement for antibradycardia pacing were randomized to receive an A+-ICD (n=124) or a DR-ICD (n=125). Implantation details, need for ICD system revision, long-term sensing, documented arrhythmia episodes, and the respective rhythm discrimination during follow-up were analyzed. The implantation time was significantly shorter in the A+-ICD group (67±30 vs 79±30 minutes,
P
=0.003). Mean P-wave amplitudes were 3.5±0.8 mV (A+-ICD) and 3.2±0.6 mV (DR-ICD) and remained stable during the follow-up period of 12 months. Surgical revision was necessary in 13 patients in the DR-ICD and 10 in the A+-ICD group. All 593 ventricular tachyarrhythmia episodes were correctly discriminated. Sensitivity and specificity of supraventricular tachyarrhythmia discrimination were not different between the study groups.
Conclusions—
The novel A+-ICD system can be implanted faster and is equivalent to a standard DR-ICD with regard to the detection of ventricular tachyarrhythmias and supraventricular tachyarrhythmias. It represents a useful alternative to obtain atrial sensing.
Clinical Trial Registration—
URL:
http://www.clinicaltrials.gov
. Unique identifier: NCT00324662.
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Affiliation(s)
- Christian Sticherling
- From the University Hospital Basel (C.S.), Basel, Switzerland; Heart Center, University of Göttingen (M.Z.), Göttingen; Charité (S.S.), Campus Benjamin Franklin, Berlin; Schwarzwald-Baar-Klinikum (U.M.), Villingen-Schwenningen; University Hospital of Münster (L.E.), Münster; Vivantes-Humboldt Klinikum (S.B.), Berlin; and Hannover Medical School (M.N.), Hannover, Germany
| | - Markus Zabel
- From the University Hospital Basel (C.S.), Basel, Switzerland; Heart Center, University of Göttingen (M.Z.), Göttingen; Charité (S.S.), Campus Benjamin Franklin, Berlin; Schwarzwald-Baar-Klinikum (U.M.), Villingen-Schwenningen; University Hospital of Münster (L.E.), Münster; Vivantes-Humboldt Klinikum (S.B.), Berlin; and Hannover Medical School (M.N.), Hannover, Germany
| | - Sebastian Spencker
- From the University Hospital Basel (C.S.), Basel, Switzerland; Heart Center, University of Göttingen (M.Z.), Göttingen; Charité (S.S.), Campus Benjamin Franklin, Berlin; Schwarzwald-Baar-Klinikum (U.M.), Villingen-Schwenningen; University Hospital of Münster (L.E.), Münster; Vivantes-Humboldt Klinikum (S.B.), Berlin; and Hannover Medical School (M.N.), Hannover, Germany
| | - Udo Meyerfeldt
- From the University Hospital Basel (C.S.), Basel, Switzerland; Heart Center, University of Göttingen (M.Z.), Göttingen; Charité (S.S.), Campus Benjamin Franklin, Berlin; Schwarzwald-Baar-Klinikum (U.M.), Villingen-Schwenningen; University Hospital of Münster (L.E.), Münster; Vivantes-Humboldt Klinikum (S.B.), Berlin; and Hannover Medical School (M.N.), Hannover, Germany
| | - Lars Eckardt
- From the University Hospital Basel (C.S.), Basel, Switzerland; Heart Center, University of Göttingen (M.Z.), Göttingen; Charité (S.S.), Campus Benjamin Franklin, Berlin; Schwarzwald-Baar-Klinikum (U.M.), Villingen-Schwenningen; University Hospital of Münster (L.E.), Münster; Vivantes-Humboldt Klinikum (S.B.), Berlin; and Hannover Medical School (M.N.), Hannover, Germany
| | - Steffen Behrens
- From the University Hospital Basel (C.S.), Basel, Switzerland; Heart Center, University of Göttingen (M.Z.), Göttingen; Charité (S.S.), Campus Benjamin Franklin, Berlin; Schwarzwald-Baar-Klinikum (U.M.), Villingen-Schwenningen; University Hospital of Münster (L.E.), Münster; Vivantes-Humboldt Klinikum (S.B.), Berlin; and Hannover Medical School (M.N.), Hannover, Germany
| | - Michael Niehaus
- From the University Hospital Basel (C.S.), Basel, Switzerland; Heart Center, University of Göttingen (M.Z.), Göttingen; Charité (S.S.), Campus Benjamin Franklin, Berlin; Schwarzwald-Baar-Klinikum (U.M.), Villingen-Schwenningen; University Hospital of Münster (L.E.), Münster; Vivantes-Humboldt Klinikum (S.B.), Berlin; and Hannover Medical School (M.N.), Hannover, Germany
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Silvetti MS, Drago F. Upgrading of VVIR pacemakers with nonfunctional endocardial ventricular leads to VDD pacemakers in adolescents. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2006; 29:691-6. [PMID: 16884503 DOI: 10.1111/j.1540-8159.2006.00443.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND In some children with ventricular rate responsive demand (VVIR) pacemakers (PM), transvenous leads fail for technical reasons or patient's growth. AIM The aim of this study is to describe our experience in adolescents with a nonfunctional ventricular lead in whom the lead was abandoned and an additional VDD lead was implanted. Of the 136 children who received a VVIR PM with an endocardial lead in our center, seven patients aged 7 (0.3-12) years [median (range)] at initial implantation, after 10 (5-15) years showed lead malfunction and underwent atrial synchronous ventricular inhibited pacing (VDD) PM upgrading at 16 (10-20) years. RESULTS The VDD lead was inserted through the ipsilateral subclavian vein in five patients, the contralateral in two (venous occlusion in one and for operator choice in the first patient). The tip was positioned into the right ventricular apex, the atrial dipole along the lateral atrial wall. Fluoroscopy times were not significantly different from those measured in SSI PM implantation and in VVIR dual-chamber demand pacing (VVIR-DDD) upgrading. There were no intraprocedural complications. Follow-up duration is 12 (6-62) months. The VDD PM showed good function, no undersensing or oversensing. Tricuspid damage, new venous occlusion, and "twisting" of the two leads at x-ray were not documented. The first patient showed an infection of the old PM pocket after 1 year, local pain after 3 years, and endocarditis of the leads after 5 years. CONCLUSION The upgrading of VVIR PM to VDD PM with the abandonment of the nonfunctional lead is feasible, with no intraprocedural complications and good PM function. Lead endocarditis occurred in one patient.
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Affiliation(s)
- Massimo S Silvetti
- Department of Pediatric Cardiology, Bambino Gesù Pediatric Hospital, Rome, Italy.
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Chabbar Boudet MC, Lukic A, Galache Osuna JG, De Juan Montiel J, Cay Diarte E, Diarte de Miguel JA, Placer Peralta LJ. Seguridad y eficacia de los sistemas de estimulación VDD monosonda. Rev Esp Cardiol 2006; 59:897-904. [PMID: 17020702 DOI: 10.1157/13092797] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
INTRODUCTION AND OBJECTIVES Single-lead VDD pacing provides the physiological benefits of atrioventricular synchrony with the convenience of a single-lead system. However, concern remains about the method's safety and effectiveness. METHOD In total, 700 patients with single-lead VDD pacemakers were evaluated retrospectively. The following parameters were recorded: age, sex, etiology, the symptoms and electrocardiographic diagnosis that justified pacemaker implantation, the venous access route used for implantation, atrial sensing at implantation, atrial undersensing at follow-up, the occurrence of supraventricular tachyarrhythmias, and final pacing mode. RESULTS Third-degree atrioventricular block was the main indication for pacemaker implantation (66.4%). The most commonly used venous access route was via the right cephalic vein (49.1%). At implantation, the mean atrial signal was 1.8 (4 1.15) mV. During follow-up, significant atrial undersensing occurred in 7.7% of patients; in 1.9%, it could not be corrected by device reprogramming. Uncontrollable supraventricular arrhythmias were observed in 6.4% of patients. Symptomatic sinus node disease was rare. By the end of follow-up, 91.4% of patients were still on VDD pacing, while, in 8.3%, the pacemaker had to be reprogrammed to the VVI mode. Only 0.3% required atrial lead implantation for DDD pacing. Left-side venous access during implantation was a independent predictora of atrial undersensing at follow-up. Low values of atrial detection at implant did not reach statistical signification although it showed a remarkable trend. CONCLUSIONS Single-lead VDD pacing seems to be safe and effective when appropriately indicated. Our findings are consistent with those of previously published studies.
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Affiliation(s)
- Maruan C Chabbar Boudet
- Unidad de Marcapasos, Servicio de Cardiología. Hospital Universitario Miguel Servet, Zaragoza, España.
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D'Ivernois C, Pi S, Hero M. Cardiac resynchronization therapy using a VDD lead. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2005; 28:1240-2. [PMID: 16359296 DOI: 10.1111/j.1540-8159.2005.50206.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
In heart failure patients with normal sinus node function, cardiac resynchronization therapy can be achieved with only two leads, one VDD type, and one left ventricular. This reduces the number of venous punctures, implanted leads, and possibly operation and fluoroscopic times and complication rates. We present two cases and discuss the advantages and limits of such a procedure.
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Haghjoo M, Arya A, Emkanjoo Z, Sadr-Ameli MA. Optimal Side of Implant for Single-Lead VDD Pacing: Right-Sided Versus Left-Sided Implantation. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2005; 28:384-90. [PMID: 15869669 DOI: 10.1111/j.1540-8159.2005.09459.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Atrial undersensing occurs in a considerable number of patients with single-lead VDD pacing. This study tried to determine the role of implant side in maintenance of the VDD mode in patients with isolated atrioventricular (AV) block. METHODS Eighty-two patients with isolated AV block (46 females; mean age, 58 +/- 17 years) received a single-lead VDD pacemaker (Medtronic Kappa, n = 70 and St. Jude Medical Affinity, n = 12). The patients were randomly assigned to one of two implantation groups (group I: right-sided VDD and group II: left-sided VDD). In each group, the P-wave amplitudes were determined at implantation, predischarge, 2-month, and 6-month follow-up. At each follow-up visit, stored event histograms of pacemaker were also retrieved. The atrial sensing measurements were compared between two groups. RESULTS Implantation was easier from right side (1.7 +/- 1.0 vs 2.8 +/- 1.7 attempts, P = 0.001). Implant P-wave was higher in group I compared to group II (4.2 +/- 1.7 vs 2.7 +/- 1.0 mV, P < 0.0001). During follow-up, higher P-wave amplitudes were obtained in group I both at predischarge (2.6 +/- 1.3 vs 1.4 +/- 1.1 mV, P < 0.0001), 2-month (2.8 +/- 1.8 vs 1.3 +/- 1.0 mV, P < 0.0001), and 6-month (2.9 +/- 1.7 vs 1.3 +/- 0.9 mV, P < 0.0001) evaluations but remained stable throughout the 6 months in both groups. After implantation, VDD function was better maintained in group I than group II (100% vs 90%, P = 0.026). Incidence of atrial undersensing was lower in group I than group II (P = 0.026) in last follow-up visit. CONCLUSIONS Implant side has a significant influence on atrial sensing performance in single-lead VDD pacing. Thus, right-side implantation should be the preferred approach for the implantation of VDD single-lead systems.
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Affiliation(s)
- Majid Haghjoo
- Department of Pacemaker and Electrophysiology, Shahid Rajaie Cardiovascular Center, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.
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