Anatomic GP ablation yields a significantly lower success rate over the long-term follow-up period, when compared with CPVI. Recurrences include AF and macro re-entrant atrial tachycardias.

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Background: Lead sensing differences between integrated (INT) and dedicated (DED) bipolar sensing configurations are related to the distance between the distal electrode tip to either the distal shocking coil or the ring electrode. These differences have not been specifically evaluated on the performance of intracardiac morphology template matching in a morphology discrimination (MD) algorithm. This study evaluated arrhythmia discrimination using MD with INT or DED bipolar sensing configurations.Methods: This randomized, prospective, two-group comparison study enrolled 183 pts (68±12 years, 89% male, LVEF 33±14%). All pts received a SJM ICD with the MD algorithm and were randomized to either DED or INT bipolar leads at implant. One hundred seven pts (58%) had DED bipolar leads implanted and 76 pts (42%) had INT bipolar leads. Patients were followed at 1, 3, 6, and 12 months post-implant. A clinical diagnosis was made for each arrhythmia observed, and device episodes and diagnostic data were obtained.Results: Three hundred thirty-eight spontaneous tachycardia episodes from 76 patients (42%) were analyzed. Clinical diagnoses of SVT and VT episodes were 236 (70%) vs. 102 (30%). With INT and DED bipolar leads, MD's positive predictive value (PPV) for SVT detection were 98.9% and 92.5%, respectively. MD's specificity (Sp) for VT with INT and DED leads were 92.6% and 95.1% respectively. Seventeen false positive episodes were detected with 11 inappropriate therapies (9 ATP, 2 shocks) delivered. Repeated measures analysis revealed that MD scores for true positive episodes remained stable from 1 month to 12 months (p=NS) with both lead sensing configurations.Conclusion: INT bipolar leads resulted in slightly increased MD PPV of SVT detection over DED bipolar leads; however, both lead systems have comparable MD Sp for VT. Active discriminator programming further enhances the specificity of SVT discrimination from VT.