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Incidence and Significance of Far‐Field R Wave Sensing in a VDD‐Implantable Cardioverter Defibrillator
Author(s) -
EBERHARDT FRANK,
SCHUCHERT ANDREAS,
SCHMITZ DIETMAR,
ZERM THOMAS,
MITZENHEIM SABINE,
WIEGAND UWE KH
Publication year - 2007
Publication title -
pacing and clinical electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.686
H-Index - 101
eISSN - 1540-8159
pISSN - 0147-8389
DOI - 10.1111/j.1540-8159.2007.00681.x
Subject(s) - medicine , implantable cardioverter defibrillator , cardiology , ventricular tachycardia , tachycardia , incidence (geometry) , single chamber , atrial tachycardia , lead (geology) , sinus tachycardia , atrial fibrillation , catheter ablation , physics , optics , geomorphology , geology
Background: A VDD‐implantable cardioverter‐defibrillator (ICD) provides atrioventricular (AV) synchronous stimulation when necessary and incorporates the advantages of dual chamber arrhythmia discrimination algorithms both at potentially lower costs and less periprocedural complications than a DDD‐ICD system. A prerequisite for correct dual chamber ICD function is reliable atrial sensing.Methods: We evaluated atrial near‐ and ventricular far‐field sensing and its impact on the dual‐chamber detection algorithm in 106 patients with a single‐lead VDD‐ICD during a 12‐month follow‐up period.Results: Six hundred and thirty‐nine follow‐ups were included. Mean near‐field amplitude was 3.82 ± 1.76 mV; mean far‐field amplitude was 0.31 ± 0.15 mV. 46% of patients had far‐fields >0.35 mV and 35% of patients showed atrial EGM markers corresponding to a ventricular far‐field in at least one follow‐up. Six hundred and forty‐five tachycardia episodes were evaluated. Due to far‐field sensing, three of 66 episodes (4.5%) of sinus tachycardia were misclassified as ventricular tachycardia (VT), leading to antitachycardia therapies. Delayed detection of VT was seen in a 12 of 323 episodes (3.7%) in five of 62 patients (8%) having VT events (delay 6.4 ± 6.0 seconds (range 2–24 seconds)). Stable far‐field amplitudes <0.2 mV in a follow‐up had a high negative predictive value for the occurrence of malfunction during tachycardia—conversely, high far‐field amplitudes or a high incidence of far‐field markers are only moderately correlated with malfunction.Conclusions: Ventricular far‐field sensing in a VDD‐ICD is not uncommon, however, tachycardia detection by the dual chamber algorithm is not seriously impaired by far‐field sensing.