(Circulation. 2000;101:878.)
© 2000 American Heart Association, Inc.
Clinical Investigation and Reports |
Detection of Atrial Fibrillation and Flutter by a Dual-Chamber Implantable Cardioverter-Defibrillator
ls, MDFrom Cedars-Sinai Medical Center, Los Angeles, Calif (C.D.S.); University of Heidelberg, Heidelberg, Germany (W.S.); University of Maastricht, Maastricht, the Netherlands (B.D.); University of Bonn, Bonn, Germany (W.J.); and Medtronic Inc, Minneapolis, Minn (N.V.S., W.H.O., B.D.G.).
Correspondence to Charles D. Swerdlow, MD, 8635 W. Third Street, Ste 1190 W, Los Angeles, CA 90048. E-mail swerdlow{at}ucla.edu
Background—To distinguish prolonged episodes of atrial fibrillation (AF) that require cardioversion from self-terminating episodes that do not, an atrial implantable cardioverter-defibrillator (ICD) must be able to detect AF continuously for extended periods. The ICD should discriminate between atrial tachycardia/flutter (AT), which may be terminated by antitachycardia pacing, and AF, which requires cardioversion.
Methods and Results—We studied 80 patients with AT/AF and ventricular arrhythmias who were treated with a new atrial/dual-chamber ICD. During a follow-up period lasting 6±2 months, we validated spontaneous, device-defined AT/AF episodes by stored electrograms in all patients. In 58 patients, we performed 80 Holter recordings with telemetered atrial electrograms, both to validate the continuous detection of AT/AF and to determine the sensitivity of the detection of AT/AF. Detection was appropriate in 98% of 132 AF episodes and 88% of 190 AT episodes (98% of 128 AT episodes with an atrial cycle length <300 ms). Intermittent sensing of far-field R waves during sinus tachycardia caused 27 inappropriate AT/AF detections; these detections lasted 2.6±2.0 minutes. AT/AF was detected continuously in 27 of 28 patients who had spontaneous episodes of AT/AF (96%). The device memory recorded 90 appropriate AT/AF episodes lasting >1 hour, for a total of 2697 hours of continuous detection of AT/AF. During Holter monitoring, the sensitivity of the detection of AT/AF (116 hours) was 100%; the specificity of the detection of non-AT/AF rhythms (1290 hours) was 99.99%. Of 166 appropriate episodes detected as AT, 45% were terminated by antitachycardia pacing.
Conclusions—A new ICD detects AT/AF accurately and continuously. Therapy may be programmed for long-duration AT/AF, with a low risk of underdetection. Discrimination of AT from AF permits successful pacing therapy for a significant fraction of AT.
Key Words: atrial fibrillation • defibrillators, implantable • arrhythmia • atrial flutter
This article has been cited by other articles:
 |
|
 |
|
  R. P. Ricci, A. Quesada, J. Almendral, F. Arribas, C. Wolpert, P. Adragao, M. Zoni-Berisso, X. Navarro, T. DeSanto, A. Grammatico, et al. Dual-chamber implantable cardioverter defibrillators reduce clinical adverse events related to atrial fibrillation when compared with single-chamber defibrillators: a subanalysis of the DATAS trial Europace, May 1, 2009; 11(5): 587 - 593. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. P. Bhavnani, C. I. Coleman, C. M. White, C. A. Clyne, R. Yarlagadda, D. Guertin, and J. Kluger Association between statin therapy and reductions in atrial fibrillation or flutter and inappropriate shock therapy Europace, July 1, 2008; 10(7): 854 - 859. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. E. Epstein, J. P. DiMarco, K. A. Ellenbogen, N.A. M. Estes III, R. A. Freedman, L. S. Gettes, A. M. Gillinov, G. Gregoratos, S. C. Hammill, D. L. Hayes, et al. ACC/AHA/HRS 2008 Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the ACC/AHA/NASPE 2002 Guideline Update for Implantation of Cardiac Pacemakers and Antiarrhythmia Devices) Developed in Collaboration With the American Association for Thoracic Surgery and Society of Thoracic Surgeons J. Am. Coll. Cardiol., May 27, 2008; 51(21): e1 - e62. [Full Text] [PDF]
|
|
|
|
 |
|
 Writing Committee Members, A. E. Epstein, J. P. DiMarco, K. A. Ellenbogen, N.A. M. Estes III, R. A. Freedman, L. S. Gettes, A. M. Gillinov, G. Gregoratos, S. C. Hammill, et al. ACC/AHA/HRS 2008 Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the ACC/AHA/NASPE 2002 Guideline Update for Implantation of Cardiac Pacemakers and Antiarrhythmia Devices): Developed in Collaboration With the American Association for Thoracic Surgery and Society of Thoracic Surgeons Circulation, May 27, 2008; 117(21): e350 - e408. [Full Text] [PDF]
|
|
|
|
|
|
R. Gradaus, K. Seidl, T. Korte, E. Himmrich, H. Wieneke, A. Schuchert, W. Bauer, J. Gerss, C. G. Wollmann, M. Borggrefe, et al. Reduction of ventricular tachyarrhythmia by treatment of atrial fibrillation in ICD patients with dual-chamber implantable cardioverter/defibrillators capable of atrial therapy delivery: the REVERT-AF Study Europace, July 1, 2007; 9(7): 534 - 539. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Gulizia, S. Mangiameli, S. Orazi, G. Chiaranda, G. Boriani, G. Piccione, N. DiGiovanni, A. Colletti, C. Puntrello, G. Butera, et al. Randomized comparison between Ramp and Burst+ atrial antitachycardia pacing therapies in patients suffering from sinus node disease and atrial fibrillation and implanted with a DDDRP device Europace, July 1, 2006; 8(7): 465 - 473. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Capucci, M. Santini, L. Padeletti, M. Gulizia, G. Botto, G. Boriani, R. Ricci, S. Favale, F. Zolezzi, N. Di Belardino, et al. Monitored Atrial Fibrillation Duration Predicts Arterial Embolic Events in Patients Suffering From Bradycardia and Atrial Fibrillation Implanted With Antitachycardia Pacemakers J. Am. Coll. Cardiol., November 15, 2005; 46(10): 1913 - 1920. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
N. Sadoul, R. Mletzko, F. Anselme, R. Bowes, W. Schols, C. Kouakam, G. Casteigneau, R. Luise, N. Iscolo, E. Aliot, et al. Incidence and Clinical Relevance of Slow Ventricular Tachycardia in Implantable Cardioverter-Defibrillator Recipients: An International Multicenter Prospective Study Circulation, August 16, 2005; 112(7): 946 - 953. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. W. Israel, G. Gronefeld, J. R. Ehrlich, Y.-G. Li, and S. H. Hohnloser Long-term risk of recurrent atrial fibrillation as documented by an implantable monitoring device: Implications for optimal patient care J. Am. Coll. Cardiol., January 7, 2004; 43(1): 47 - 52. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Quesada, J.ús Almendral, F. Arribas, R. Ricci, C. Wolpert, P. Adragao, E. Cobo, X. Navarro, and on behalf DATAS investigators The DATAS rationale and design: a controlled, randomized trial to assess the clinical benefit of dual chamber (DDED) defibrillator Europace, January 1, 2004; 6(2): 142 - 150. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. Aliot, Rém. Nitzsché, and A. Ripart Arrhythmia detection by dual-chamber implantable cardioverter defibrillators: A review of current algorithms Europace, January 1, 2004; 6(4): 273 - 286. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. V. Glotzer, A. S. Hellkamp, J. Zimmerman, M. O. Sweeney, R. Yee, R. Marinchak, J. Cook, A. Paraschos, J. Love, G. Radoslovich, et al. Atrial High Rate Episodes Detected by Pacemaker Diagnostics Predict Death and Stroke: Report of the Atrial Diagnostics Ancillary Study of the MOde Selection Trial (MOST) Circulation, April 1, 2003; 107(12): 1614 - 1619. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
B. Nowak, J. Sperzel, F. Rauscha, L. Mont, J. Alzueta, P. J. Senden, and J. Meyer Diagnostic value of onset-recordings and marker annotations in dual chamber pacemaker stored electrograms Europace, January 1, 2003; 5(1): 103 - 109. [Abstract] [PDF]
|
|
|
|
|
|
B. Hügl, C. W. Israel, C. Unterberg, T. Lawo, J. C. Geller, I. M. Kennis, D. E. Euler, J. L. Koehler, D. A. Hettrick, and on behalf of the AT500 Verification Study Investig Incremental programming of atrial anti-tachycardia pacing therapies in bradycardia-indicated patients: effects on therapy efficacy and atrial tachyarrhythmia burden Europace, January 1, 2003; 5(4): 403 - 409. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M.J.P. Raatikainen and H.V. Huikuri Management of atrial fibrillation in patients with implantable cardioverter defibrillator. Do all need a dual chamber device? Eur. Heart J., September 2, 2002; 23(18): 1412 - 1414. [Full Text] [PDF]
|
|
|
|
|
|
R. Ricci, C. Pignalberi, M. Disertori, A. Capucci, L. Padeletti, G. Botto, S. Toscano, F. Miraglia, A. Grammatico, and M. Santini Efficacy of a dual chamber defibrillator with atrial antitachycardia functions in treating spontaneous atrial tachyarrhythmias in patients with life-threatening ventricular tachyarrhythmias Eur. Heart J., September 2, 2002; 23(18): 1471 - 1479. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. M. Stein, D. E. Euler, R. Mehra, K. Seidl, D. J. Slotwiner, S. Mittal, S. M. Markowitz, B. B. Lerman, and Jewel AF Worldwide Investigators Do atrial tachyarrhythmias beget ventricular tachyarrhythmias in defibrillator recipients? J. Am. Coll. Cardiol., July 17, 2002; 40(2): 335 - 340. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. Shirayama, H. Shiraishi, S. Yoshida, Y. Matoba, H. Imai, and M. Nakagawa Atrial fibrillation threshold predicted long-term efficacy of pharmacological treatment of patients without structural heart disease Europace, January 1, 2002; 4(4): 383 - 389. [Abstract] [PDF]
|
|
|
|
 |
|
 M. Disertori, L. Padeletti, M. Santini, P. Dini, M. Gasparini, G. Inama, M. Botto, G. Boriani, A. Capucci, R. Ricci, et al. Antitachycardia pacing therapies to terminate atrial tachyarrhythmias: the AT500 Italian Registry Eur. Heart J. Suppl., November 1, 2001; 3(suppl_P): P16 - P24. [Abstract] [PDF]
|
|
|
|
|
|
P. A. Friedman, B. Dijkman, E. N. Warman, H. A. Xia, R. Mehra, M. S. Stanton, and S. C. Hammill Atrial Therapies Reduce Atrial Arrhythmia Burden in Defibrillator Patients Circulation, August 28, 2001; 104(9): 1023 - 1028. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. W. Adler II, C. Wolpert, E. N. Warman, S. K. Musley, J. L. Koehler, and D. E. Euler Efficacy of Pacing Therapies for Treating Atrial Tachyarrhythmias in Patients With Ventricular Arrhythmias Receiving a Dual-Chamber Implantable Cardioverter Defibrillator Circulation, August 21, 2001; 104(8): 887 - 892. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R.N.W. Hauer, E. Aliot, M. Block, A. Capucci, B. Luderitz, M. Santini, and P.E. Vardas Indications for implantable cardioverter defibrillator (ICD) therapy. Study Group on Guidelines on ICDs of the Working Group on Arrhythmias and the Working Group on Cardiac Pacing of the European Society of Cardiology Eur. Heart J., July 1, 2001; 22(13): 1074 - 1081. [PDF]
|
|
|
|
 |
|
 G. Gronefeld and S. H Hohnloser What do implantable cardioverter/defibrillators teach us about the mechanisms of sudden cardiac death? Cardiovasc Res, May 1, 2001; 50(2): 232 - 241. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. H. Falk Atrial Fibrillation N. Engl. J. Med., April 5, 2001; 344(14): 1067 - 1078. [Full Text] [PDF]
|
|
|
|
|
|
R. N. W. Hauer, E. Aliot, M. Block, A. Capucci, B. Luderitz, M. Santini, and P. E. Vardas Indications for implantable cardioverter defibrillator (ICD) therapy: Study Group on Guidelines on ICD of the Working Group on Arrhythmias and the Working Group on Cardiac Pacing of the European Society of Cardiology Europace, January 1, 2001; 3(3): 169 - 176. [PDF]
|
|
|
|
|
|
W. Xu, H.-F. Tse, F. H.Y. Chan, P. C. W. Fung, K. L.-F. Lee, and C.-P. Lau New Bayesian Discriminator for Detection of Atrial Tachyarrhythmias Circulation, March 26, 2002; 105(12): 1472 - 1479. [Abstract] [Full Text] [PDF]
|
|