Journal Article

First worldwide clinical experience with a new dual chamber implantable cardioverter defibrillator

C. Sticherling, A. Schaumann, T. Klingenheben and S. H. Hohnloser

in EP Europace

Published on behalf of European Heart Rhythm Association of the European Society of Cardiology (ESC)

Volume 1, issue 2, pages 96-102
Published in print April 1999 | ISSN: 1099-5129
Published online April 1999 | e-ISSN: 1532-2092 | DOI: http://dx.doi.org/10.1053/eupc.1998.0023
First worldwide clinical experience with a new dual chamber implantable cardioverter defibrillator

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Aims

The need for physiological pacing and for improving the ability to discriminate atrial from ventricular tachy-arrhythmias has prompted the development of dual chamber implantable cardioverter/defibrillators (ICDs).

Methods

Fifty-two patients were implanted with a newly developed dual-chamber ICD providing rate-responsive physiological pacing (Ventak AV II DR). The device possesses two new arrhythmia detection algorithms (‘atrial fibrillation rate threshold’ and ‘ventricular to atrial rate relationship’) in addition to commonly used features such as ‘onset’ and ‘stability’. During implantation, the atrial and ventricular lead impedances and pacing thresholds were determined together with the defibrillation threshold. Prior to discharge, attempts were made to induce both atrial and ventricular tachyarrhythmias in order to test those new detection criteria. All patients were followed for at least 3 months.

Results

The device was successfully implanted in all 52 patients. Placement of the atrial lead was successful in 50/52 patients (96%; P-wave 3·2±1·4 mV; impedance 576±123 |gQ; atrial pacing threshold 1·2±0·9 V). Prior to discharge, 32 episodes of atrial fibrillation (AF) alone, 38 episodes of AF with ventricular fibrillation and 10 episodes of AF with monomorphic ventricular tachycardia were induced in 33/50 patients (66%) and all were appropriately classified by the detection algorithm. During the 3 months follow-up, 12 patients (23%) had appropriate and successful therapies for ventricular arrhythmias, while four patients (8%) experienced inappropriate ICD therapies. Although all these episodes were detected correctly as supraventricular arrhythmias by the device, therapy was delivered because of incorrect or incomplete programming. In all cases reprogramming of the device resolved the problem.

Conclusion

Implantation of dual chamber ICDs is feasible and appears to improve discrimination of supraventricular from ventricular tachyarrhythmias. In addition, patients with tachyarrhythmias and concomitant bradyarrhythmias may benefit from simultaneous physiological pacing. However, implantation and follow-up of such patients should be performed at experienced centres since both surgical handling and programming of these devices is more difficult and complex than conventional ICDs.

Keywords: Implantable cardioverter/defibrillator; sudden cardiac death; dual chamber pacing; atrial fibrillation; discrimination of atrial and ventricular arrhythmias; inappropriate ICD shock

Journal Article.  0 words. 

Subjects: Cardiovascular Medicine

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