Use of Atrial and Ventricular Electrograms from a Dual Chamber Implantable Cardioverter Defibrillator to Elucidate a Complex Dysrhythmia

Greenberg, Richard M.; Degeratu, Florin T.

doi:10.1111/j.1540-8159.1998.tb00023.x

Cited by 8 publications

(5 citation statements)

References 3 publications

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“…Each participating center determined which of the following two defibrillation implant criteria would be applied: (1) two consecutive successes out of the first two attempts at # 24 J, or (2) the estab- Table II. intervals differs by more than 40 ms than 40 ms as compared to the as compared to the previous 8 AV previous 8…”

Section: Defibrillation Testing At Implantmentioning

confidence: 81%

“…7 Also, storage of atrial electrograms assists in diagnosis of the type of arrhythmia and the appropriateness of detection. 8,9 The aim of this article is to report on the evaluation of a dual chamber ICD that incorporates a detection algorithm for discrimination of supraventricular tachyarrhythmias from VT/VF and enhanced electrogram storage capacity.…”

Section: Introductionmentioning

confidence: 99%

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Experience with a Dual Chamber Implantable Defibrillator

Kühlkamp

Wilkoff

Brown

et al. 2002

Pacing Clinical Electrophis

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An implantable defibrillator with dual chamber pacing may have advantages for pacing, sensing, and detection of brady- and tachyarrhythmias. This study evaluates the safety and performance of a dual chamber implantable cardioverter defibrillator that incorporates an algorithm to discriminate supraventricular from ventricular arrhythmias. The 300 patients in this study had the device implanted for the following indications: ventricular tachycardia (47%), sudden cardiac death survivorship (51%), and prophylactic implants (2%). Patients received dual chamber pacing for accepted bradyarrhythmic (51.7%) or investigational indications. During a mean follow-up period of 1.7 months a total of 1,092 arrhythmia episodes in 96 patients were fully documented in the device memory: 66 patients experienced a total of 796 ventricular tachyarrhythmia episodes and 42 experienced a total of 296 supraventricular episodes. The device appropriately detected 100% of sustained ventricular tachyarrhythmias while reducing the inappropriate detection of supraventricular tachyarrhythmias by 72% compared to single chamber rate only detection. The positive predictive value was 90.5% for ventricular tachyarrhythmia detection in episodes that exceeded the tachycardia detection rate. Adverse events observed in at least 2% of the patients were incisional pain (22%), inappropriate ventricular detection (7%), atrial lead dislodgement (4%), atrial oversensing/undersensing (3%), hematoma (3%), incessant ventricular tachyarrhythmia (2%), and pneumothorax (2%). There were 13 deaths, none of which were attributed to device failure. The Gem DR is safe and effective for the detection and treatment of ventricular tachyarrhythmias. The dual chamber detection algorithm appropriately recognized supraventricular tachycardia with rapid ventricular rates 72% of the time while maintaining 100% detection of sustained ventricular tachyarrhythmias.

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Section: Defibrillation Testing At Implantmentioning

confidence: 81%

Section: Introductionmentioning

confidence: 99%

Experience with a Dual Chamber Implantable Defibrillator

Kühlkamp

Wilkoff

Brown

et al. 2002

Pacing Clinical Electrophis

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“…23 Finally, with the availability of dual chamber recordings, more information is provided to evaluate the nature of arrhythmias and to facilitate the interpretation of complex events. 24,25 A recently published study of dual chamber ICDs used stored EGMs to validate spontaneous, device-defined atrial tachycardia/flutter and atrial fibrillation episodes. 26 This analysis showed that intermittent sensing of far-field R waves during sinus tachycardia caused inappropriate detection of atrial tachycardia/flutter.…”

Section: Stored Egms In Icdsmentioning

confidence: 99%

Pacemaker Stored Electrograms: Teaching Us What Is Really Going On in Our Patients

Nowak

2002

Pacing Clinical Electrophis

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Stored electrograms (EGMs), well-known diagnostic tools in implantable cardioverter defibrillators, have now been incorporated in pacemakers as well, thereby increasing their diagnostic capabilities. The clinician can detect and diagnose patient arrhythmias with EGMs and directly validate diagnostic data stored by the devices. The appropriateness of detection algorithms can also be judged. Initial experiences with pacemaker EGMs reveals their potential to detect and diagnose sensing or detection algorithm problems. These so-called "false-positive" EGMs help to optimize pacemaker programming. Date and time stamp can correlate an event to patient symptoms. Recent advances, like onset recordings and marker annotation, have further increased the effectiveness of stored EGMs. The use of patient-triggered magnet-stored EGMs facilitates diagnostic workups in symptomatic pacemaker patients and reveals nondevice related symptoms in a considerable number of cases. Stored EGMs in pacemakers will soon be a standard diagnostic tool that can illustrate what is really going on in our patients.

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“…On the other hand, the intracardiac electrogram width showed a large intra-individual variation [52] and resulted in reprogramming of 13 of 16 patients using repeated exercise testing [53]. Case reports and low-volume studies document improvement in discrimination properties of dual-chamber ICDs [25,30,54,55], but controversial observations are published as well [56•]. The multicenter ASTRID (Atrial Sensing to Reduce Inappropriate Defibrillation) trial compared rate detection and enhanced detection in 148 patients followed up to 6 months and documented a significant decrease in the incidence of inappropriate therapies in the enhanced arm (14/79; 18%) in comparison to the control arm (25/70; 36%) with a sensitivity of 99.8% VTA detection and specificity of 94% [57].…”

Section: Newer Pacing Indications In Implantable Cardioverter-defibrimentioning

confidence: 97%

“…Detection of atrial fibrillation in single-chamber ICDs remains limited, especially in cases with 1:1 to 2:1 AV conduction [25] (Fig. 1).…”

Section: Atrial Fibrillation In Implantable Cardioverterdefibrillatormentioning

confidence: 97%

Implantable dual-chamber cardioverter-defibrillator-pacemaker

2000

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The fifth generation of implantable cardioverter-defibrillators offer enhanced modes of detection of atrial and ventricular arrhythmias, antitachycardia pacing and shocks, multiprogrammability, intracardiac electrogram storage, and all functions of antibradycardia dual-chamber pacing including rate responsiveness and mode switching. There is no consensus on the indications for dual-chamber pacemaker defibrillator systems. This review focuses on the four major options of newer devices that might benefit patients: 1) permanent dual-chamber pacing in ischemic coronary disease patients, 2) detection and management of atrial fibrillation or other atrial tachyarrhythmias, 3) some newer indications for pacing, and 4) the suppression of inappropriate interventions. On the basis of published data, newer indications for the dual-chamber systems, advantages and limitations, and future perspectives are discussed.

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Use of Atrial and Ventricular Electrograms from a Dual Chamber Implantable Cardioverter Defibrillator to Elucidate a Complex Dysrhythmia

Cited by 8 publications

References 3 publications

Experience with a Dual Chamber Implantable Defibrillator

Experience with a Dual Chamber Implantable Defibrillator

Pacemaker Stored Electrograms: Teaching Us What Is Really Going On in Our Patients

Implantable dual-chamber cardioverter-defibrillator-pacemaker

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