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Long‐Term Stability and Clinical Utility of Amplified Atrial Electrograms in a Single‐Lead ICD System with Floating Atrial Electrodes
Author(s) -
WORDEN NICOLE E.,
ALQASRAWI MUSAB,
MAZUR ALEXANDER
Publication year - 2016
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/pace.12967
Subject(s) - medicine , cardiology , atrial fibrillation , sinus rhythm , supraventricular tachycardia , atrial tachycardia , lead (geology) , ventricular tachycardia , tachycardia , catheter ablation , geomorphology , geology
Background Available atrial electrograms in implantable cardioverter defibrillators (ICDs) improve arrhythmia diagnosis, allow monitoring for atrial fibrillation, and may reduce the risk of inappropriate therapies. A recently introduced ICD system using a single‐lead with floating atrial electrodes provides diagnostic capability of a dual‐chamber system without placing an additional lead. Data on long‐term clinical performance of this system are limited. Methods We retrospectively analyzed data from 35 consecutive patients implanted with Biotronik VR‐T DX devices and Linox Smart DX leads. (Biotronik, SE & Co., Berlin, Germany) Results Of 35 patients (77% male, age 52 ± 11.28 years), 32 were followed for a mean of 432 ± 197 days (range 56–765). During implantation, average preamplified and amplified sinus P‐wave amplitudes were 2.61 ± 1.39 mV (range 0.9–6.8 mV) and 8.7 ± 4.51 mV (range 1.4–18 mV), respectively. Despite statistically significant variations, the amplified P‐wave amplitude measurements (calculated mean values over 3 months) remained within a clinically acceptable range during follow‐up (5.4–8.7 mV). R‐wave amplitude and ventricular pacing threshold measurements were stable over time. A total of 13 stored arrhythmia events (three ventricular tachycardia, eight supraventricular tachycardia, two atrial fibrillation) were reviewed. All of them showed readily interpretable atrial electrograms. Eight out of 10 (80%) supraventricular events were correctly classified by the device. Three patients received inappropriate ICD therapies. Conclusion The single‐lead ICD system using a floating atrial dipole provides reliable recording of atrial signals during sinus rhythm and arrhythmias. Our data suggest that the system may offer diagnostic advantages of a dual‐chamber device without potential risks of an additional atrial lead.