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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
Author(s) -
Biffi Mauro,
Iori Matteo,
De Maria Elia,
Bolognesi Maria Giulia,
Placci Angelo,
Calvi Valeria,
Allocca Giuseppe,
Ammendola Ernesto,
Carinci Valeria,
Boggian Giulio,
Saporito Davide,
Grassini Diego,
Giacopelli Daniele,
Statuto Giovanni,
Ziacchi Matteo
Publication year - 2020
Publication title -
journal of cardiovascular electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.193
H-Index - 138
eISSN - 1540-8167
pISSN - 1045-3873
DOI - 10.1111/jce.14396
Subject(s) - medicine , implantable cardioverter defibrillator , atrial fibrillation , incidence (geometry) , confidence interval , hazard ratio , atrial tachycardia , cardiology , ventricular tachycardia , catheter ablation , physics , optics
Atrial tachycardia/fibrillation (AT/AF) episodes are common in implantable cardioverter‐defibrillator (ICD) recipients and can be undetected by standard single‐chamber devices. This study aims to explore whether a single‐lead ICD with an atrial dipole (ICD DX; BIOTRONIK SE & Co, Berlin, Germany) could improve the AT/AF diagnosis and management as compared to standard ICD (ICD VR). Methods and Results We selected patients without AT/AF history from the THINGS registry which included consecutive patients implanted with ICD for standard indications. The ICD VR and the ICD DX groups included 236 (62.8%) and 140 (37.2%) patients, respectively, and had no significant differences in baseline characteristics. During a median follow‐up of 27 months, there were 7 AT/AF diagnoses in the ICD VR and 18 in the ICD DX group. The 2‐year incidence of AT/AF diagnosis was 3.6% (95% confidence interval [CI]: 1.6%‐9.6%) for the ICD VR and 11.4% (95% CI: 6.8%‐18.9%) for the ICD DX group (adjusted hazard ratio [HR]: 3.85 [95% CI: 1.58‐9.41]; P = .003). Initiation of oral anticoagulation (OAC) due to AT/AF diagnosis was reported in 15 patients. The 2‐year incidence of OAC onset was 3.6% (95% CI: 1.6%‐7.8%) for the ICD VR and 6.3% (95% CI: 3.0%‐12.7%) for ICD DX group (adjusted HR: 1.99 [95% CI: 0.72‐5.56]; P = .184). Conclusion We observed that atrial sensing capability in single‐chamber ICD patients without evidence of atrial arrhythmias at implant is associated with a greater likelihood of detecting AT/AF episodes. The management of these diagnosed arrhythmias often led to clinical interventions, mainly represented by initiation of OAC therapy.