Atrial Fibrillation Therapy in Patients with a CRT Defibrillator with Wireless Telemetry

Abstract

Background: Atrial fibrillation (AF) is a major cause of morbidity and mortality, especially in patients with congestive heart failure.Objectives: (PACE 2009; 32:13-23) implantable cardioverter defibrillator, atrial fibrillation, atrial shock therapy, cardioversion, cardiac resynchronization therapy, wireless telemetry

Cardiac Resynchronization and Atrial Fibrillation: What's New?

“…Such follow‐up systems can automatically send reports and special alerts on a daily basis, thereby allowing physicians to respond more proactively to paroxysmal or asymptomatic AF. AF is more likely to be detected early with daily remote monitoring compared to traditional follow‐up visits 38–44 …”

“…Contemporary CRT‐D devices can provide a wide range of therapies for the prevention and termination of atrial tachyarrhythmias 58–63 . Such devices have been available for some time but they never became widely used 58–63 . There is now renewed interest in view of the Treatment of Atrial Fibrillation with a Dual Defibrillator in Heart Failure (TRADE‐HF) trial which is being conducted to evaluate the role of CRT ICDs with the capacity to deliver atrial therapy in HF 59 .…”

Significant Increase in the Incidence of Ventricular Arrhythmic Events After an Intrathoracic Impedance Change Measured With a Cardiac Resynchronization Therapy Defibrillator

“…10 In brief, 71% were male, 93% had NYHA class III HF, 56% had ischemic cardiomyopathy, and the median age was 68.3 years. The mean QRS duration was 157.0±23.4 ms, and the mean LVEF was 23.3±6.8%.…”

“…The detailed patient selection criteria have been previously described. 10 Briefly, patients were eligible if they had a standard indication for a CRT-D device, QRS duration ≥120 ms, New York Heart Association (NYHA) functional class III or IV HF, and left ventricular ejection fraction (LVEF) ≤35%, despite optimal medical therapy. Patients with permanent atrial fibrillation (AF) were excluded.…”

Concurrent Cardioversion of Atrial Fibrillation during ICD Shock Testing

“…30 However, this rate does not reflect a cardioversion rate through active intervention (drugs or cardioversion), but is merely a sign of long-term effect of reverse remodeling, as this rate is based on spontaneous resumption of SR. [31][32][33] Another study showed that programmed atrial shocks delivered by the ICD result in cardioversion from AF to SR in 98.2%. 34 However, studies differ highly in the methodology from our project and can therefore not be compared. To our knowledge there are currently no studies comparing the cardioversion rate from shocks delivered by the device or the PACE, Vol.…”