(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
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