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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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Carinci V, Ziacchi M, Iori M, De Maria E, Bolognesi MG, Zardini M, Calvi V, Allocca G, Ammendola E, Boggian G, Saporito D, Giorgi D, Statuto G, Giacopelli D, Grassini D, Biffi M. Incremental value of atrial sensing in the diagnosis of ICD recordings: findings from the THINGS registry. J Cardiovasc Med (Hagerstown) 2023; 24:62-64. [PMID: 36219152 DOI: 10.2459/jcm.0000000000001382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
| | | | | | | | | | | | - Valeria Calvi
- Azienda O.U. Policlinico G. Rodolico - San Marco, Catania
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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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4
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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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5
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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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Marinaccio L, Giacopelli D, Resta M, Fabbian C, Romanato G, Borgato M, Vetta F, Marchese D. Interatrial conduction time from electrograms of cardiac resynchronization therapy devices with left ventricular sensing. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2020; 43:791-796. [PMID: 32452058 DOI: 10.1111/pace.13960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 05/07/2020] [Accepted: 05/20/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND The interatrial conduction time (IACT) is relevant for atrioventricular delay optimization in cardiac resynchronization therapy (CRT) devices. However, this information cannot be easily used as it requires invasive measurements. We tested whether electrical activation of left atrium (LA) could be detected in CRT devices with left ventricular (LV) sensing and used to estimate IACT. METHODS The presence of LA activation on LV channel was evaluated in consecutive patients implanted with CRT and quadripolar LV leads whose sensing was temporarily set in the most proximal polarity (Ring LV4-housing). Estimates of IACT during sinus rhythm and atrial pacing were measured and compared with the values obtained with invasive catheterization of coronary sinus. RESULTS Among six patients (50% female; mean age 73.3 ± 4.9 years) included in the analysis, four (66%) had a visible LA signal on the LV channel. The mean IACT measured with device electrograms was 71 ± 8 ms and 133 ± 15 ms during sinus rhythm and atrial pacing, respectively. These values were equivalent to the measurements obtained during invasive catheterization. Both patients without evidence of LA activation had an LV lead with a short total interelectrodes distance (46 mm) resulting in a significant anatomical distance between Ring LV4 and LA. CONCLUSIONS In CRT devices with left ventricular sensing, LA signal could be detected and used to estimate IACT especially if long-spaced electrodes are used.
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Affiliation(s)
- Leonardo Marinaccio
- Department of Cardiology, Presidio Ospedaliero di Piove di Sacco, Piove di Sacco, Italy
| | | | - Margherita Resta
- Department of Cardiology, Presidio Ospedaliero di Piove di Sacco, Piove di Sacco, Italy
| | - Clelia Fabbian
- Department of Cardiology, Presidio Ospedaliero di Piove di Sacco, Piove di Sacco, Italy
| | - Giuseppe Romanato
- Department of Cardiology, Presidio Ospedaliero di Piove di Sacco, Piove di Sacco, Italy
| | - Martina Borgato
- Department of Cardiology, Presidio Ospedaliero di Piove di Sacco, Piove di Sacco, Italy
| | | | - Domenico Marchese
- Department of Cardiology, Presidio Ospedaliero di Piove di Sacco, Piove di Sacco, Italy
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Biffi M, Iori M, De Maria E, Bolognesi MG, Placci A, Calvi V, Allocca G, Ammendola E, Carinci V, Boggian G, Saporito D, Grassini D, Giacopelli D, Statuto G, Ziacchi M. The role of atrial sensing for new‐onset atrial arrhythmias diagnosis and management in single‐chamber implantable cardioverter‐defibrillator recipients: Results from the THINGS registry. J Cardiovasc Electrophysiol 2020; 31:846-853. [DOI: 10.1111/jce.14396] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 01/30/2020] [Accepted: 02/11/2020] [Indexed: 01/06/2023]
Affiliation(s)
- Mauro Biffi
- Policlinico S. Orsola‐Malpighi, Azienda OspedalieroUniversitaria di BolognaBologna Italy
| | - Matteo Iori
- Arcispedale Santa Maria Nuova IRCCSReggio Emilia Italy
| | | | | | - Angelo Placci
- Azienda OspedalieroUniversitaria di ParmaParma Italy
| | - Valeria Calvi
- Policlinico G. Rodolico, Az. O.U. Policlinico—V. EmanueleCatania Italy
| | | | | | | | | | | | | | | | - Giovanni Statuto
- Policlinico S. Orsola‐Malpighi, Azienda OspedalieroUniversitaria di BolognaBologna Italy
| | - Matteo Ziacchi
- Policlinico S. Orsola‐Malpighi, Azienda OspedalieroUniversitaria di BolognaBologna Italy
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8
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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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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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10
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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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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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12
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Quartieri F, Giacopelli D, Iori M, Bottoni N. Implantation of single lead cardioverter defibrillator with floating atrial sensing dipole in a pregnant patient without using fluoroscopy. Indian Pacing Electrophysiol J 2016; 16:70-72. [PMID: 27676164 PMCID: PMC5031860 DOI: 10.1016/j.ipej.2016.08.004] [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: 11/02/2015] [Revised: 04/25/2016] [Accepted: 08/18/2016] [Indexed: 10/26/2022] Open
Abstract
In this case report, we look into the implant procedure of a single-lead ICD with floating atrial sensing dipole in a pregnant woman, without using fluoroscopy. This system benefits the proper positioning of the lead. This is possible thanks to the simultaneous display of both the atrial and ventricular dipoles on the electro-anatomical mapping system. This technique may be taken into consideration for the few rare cases where fluoroscopy is absolutely contraindicated.
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Affiliation(s)
- Fabio Quartieri
- Cardiologia Interventistica, Arcispedale Santa Maria Nuova, Reggio Emilia (RE), Italy.
| | | | - Matteo Iori
- Cardiologia Interventistica, Arcispedale Santa Maria Nuova, Reggio Emilia (RE), Italy
| | - Nicola Bottoni
- Cardiologia Interventistica, Arcispedale Santa Maria Nuova, Reggio Emilia (RE), Italy
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13
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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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14
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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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15
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Malagù M, Toselli T, Bertini M. Single lead catheter of implantable cardioverter-defibrillator with floating atrial sensing dipole implanted via persistent left superior vena cava. World J Cardiol 2016; 8:323-326. [PMID: 27152145 PMCID: PMC4840166 DOI: 10.4330/wjc.v8.i4.323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Revised: 12/22/2015] [Accepted: 01/07/2016] [Indexed: 02/06/2023] Open
Abstract
Persistent left superior vena cava (LSVC) is a congenital anomaly with 0.3%-1% prevalence in the general population. It is usually asymptomatic but in case of transvenous lead positioning, i.e., for pacemaker or implantable cardioverter defibrillator (ICD), may be a cause for significant complications or unsuccessful implantation. Single lead ICD with atrial sensing dipole (ICD DX) is a safe and functional technology in patients without congenital abnormalities. We provide a review of the literature and a case report of successful implantation of an ICD DX in a patient with LSVC and its efficacy in treating ventricular arrhythmias.
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Maria ED, Giacopelli D. Subclinical Atrial Tachyarrhythmias:Implantable Devices and Remote Monitoring. J Atr Fibrillation 2015; 8:1249. [PMID: 27957222 DOI: 10.4022/jafib.1249] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2015] [Revised: 08/03/2015] [Accepted: 09/07/2015] [Indexed: 12/20/2022]
Abstract
Atrial fibrillation (AF) and Atrial Tachyarrhythmias (AT) are the most common clinical arrhythmias and their worst issue is a well-recognized correlation with ischemic stroke. High incidence of "subclinical" AF/ATs has been demonstrated in several trials (TRENDS, ASSERT, CRYSTAL AF, EMBRACE) in patients with both cardiac implantable electronic devices (CIEDS) and external loop recorders. Moreover, a relationship between device-detected AF/ATs and stroke risk has been observed in the same studies. However, while the net clinical benefit of the antithrombotic treatment is well established in patients with "clinical" atrial fibrillation, there may be a lower benefit in patients with device-detected arrhythmias. Subclinical AF/ATs may be considered as a marker of stroke risk rather than the proximate cause and their burden may be used in combination with CHA2DS2-VASC and HAS-BLED scores to identify high-risk population who deserves anticoagulation. Today the remote monitoring associated with the CIEDs is effective in the early detecting of AF/ATs by avoiding delays in the therapy evaluation, as demonstrated by several trials (TRUST, CONNECT, COMPAS). However clinical evidence for stroke risk reduction by remote monitoring is still awaited; the recent trial IMPACT failed to demonstrate that the handling of the anticoagulation therapy guided by device-detected ATs and remote monitoring improves the patients' outcome. The challenges for clinicians are to deal with the huge data entry, to define new organizational models, to improve device patient management and to continuously update AF guidelines in according to the great amount of data offered by the new technology.
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Affiliation(s)
- Elia De Maria
- Arrhythmology Cath Lab, Cardiology Unit, Ramazzini Hospital, Via Molinari 1, 41012, Carpi (Modena), Italy
| | - Daniele Giacopelli
- Biotronik Italia, Via Delle Industrie 11, 20090 Vimodrone (Milano), Italy
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Quartieri F, Giacopelli D, Iori M, Bottoni N. Atrial sensor, remote monitoring and new anticoagulant drugs: Identification and treatment of a patient with unknown and asymptomatic atrial flutter. Indian Pacing Electrophysiol J 2015; 15:177-9. [PMID: 26937114 PMCID: PMC4750127 DOI: 10.1016/j.ipej.2015.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
This case report describes how new tools and technologies can drive a different approach in the management of arrhythmic patients. An unknown and asymptomatic atrial flutter was detected by the atrial sensor mounted in a single lead implantable cardioverter defibrillator. Moreover daily remote monitoring of the device allowed early notification and prompt clinical reaction. Anticoagulant therapy onset, radiofrequency ablation and the following anticoagulant therapy removal were driven by the device data transmissions.
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Affiliation(s)
- Fabio Quartieri
- Cardiologia Interventistica, Arcispedale Santa Maria Nuova, Reggio Emilia RE, Italy
| | - Daniele Giacopelli
- Biotronik Italia, Milano, Italy
- Corresponding author. Via delle Industrie 11, 20090 Vimodrone, MI, Italy. Tel.: +39 3491712305.
| | - Matteo Iori
- Cardiologia Interventistica, Arcispedale Santa Maria Nuova, Reggio Emilia RE, Italy
| | - Nicola Bottoni
- Cardiologia Interventistica, Arcispedale Santa Maria Nuova, Reggio Emilia RE, Italy
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