Long‐Term Stability and Clinical Utility of Amplified Atrial Electrograms in a Single‐Lead ICD System with Floating Atrial Electrodes

Worden, Nicole; Alqasrawi, Musab; Mazur, Alexander

doi:10.1111/pace.12967

Cited by 16 publications

(27 citation statements)

References 25 publications

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“…Only 3% of DX patients had sensed atrial amplitudes <1 mV at follow‐up. Our findings on the atrial sensing performance of the DX system are comparable to those of other studies examining the DX system …”

Section: Discussionsupporting

confidence: 88%

“…In our study, the adverse device‐related event rates were similar between the DX cohort and the single‐chamber cohort. Other studies have also demonstrated comparable procedural and fluoroscopy times with implantation of DX systems and conventional single‐chamber ICDs . One major limitation of the DX system is that it does not offer atrial pacing.…”

Section: Discussionmentioning

confidence: 93%

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Subclinical atrial fibrillation detection with a floating atrial sensing dipole in single lead implantable cardioverter‐defibrillator systems: Results of the SENSE trial

Thomas

Choi

Doppalapudi

et al. 2019

Cardiovasc electrophysiol

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IntroductionSubclinical atrial fibrillation (AF), in the form of cardiac implantable device‐detected atrial high rate episodes (AHREs), has been associated with increased thromboembolism. An implantable cardioverter‐defibrillator (ICD) lead with a floating atrial dipole may permit a single lead (DX) ICD system to detect AHREs. We sought to assess the utility of the DX ICD system for subclinical AF detection in patients, with a prospective multicenter, cohort‐controlled trial.Methods and ResultsOne hundred fifty patients without prior history of AF (age 59 ± 13 years; 108 [72%] male) were enrolled into the DX cohort and implanted with a Biotronik DX ICD system at eight centers. Age‐, sex‐, and left ventricular ejection fraction‐matched single‐ and dual‐chamber ICD cohorts were derived from a Cornell database and from the IMPACT trial, respectively. The primary endpoint were AHRE detection at 12 months. During median 12 months follow‐up, AHREs were detected in 19 (13%) patients in the DX, 8 (5.3%) in the single‐chamber, and 19 (13%) in the dual‐chamber cohorts. The rate of AHRE detection was significantly higher in the DX cohort compared to the single‐chamber cohort (P = .026), but not significantly different compared to the dual‐chamber cohort. There were no inappropriate ICD therapies in the DX cohort. At 12 months, only 3.0% of patients in the DX cohort had sensed atrial amplitudes less than 1.0 mV.ConclusionUse of a DX ICD lead allows subclinical AF detection with a single lead DX system that is superior to that of a conventional single‐chamber ICD system.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 93%

Subclinical atrial fibrillation detection with a floating atrial sensing dipole in single lead implantable cardioverter‐defibrillator systems: Results of the SENSE trial

Thomas

Choi

Doppalapudi

et al. 2019

Cardiovasc electrophysiol

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“…Conversely, the ICD DX (BIOTRONIK SE & Co) has direct atrial sensing capability using a single‐lead with atrial floating dipole mounted 150 mm from the lead tip (Linox Smart S DX; BIOTRONIK SE & Co). A specific algorithm amplified the atrial signal detected by the dipole up to fourfolds allowing reliable atrial rhythm monitoring despite no direct dipole contact with myocardium 8,9 . AT/AF detection algorithm was based on an atrial rate criterion nominally programmed with 36 of 48 detected atrial signal (PP) cycles exceeding a rate threshold of 200 bpm for episode onset and 20 of 24 PP cycles below the same threshold for episode termination.…”

Section: Methodsmentioning

confidence: 99%

“…A novel single‐lead ICD with an atrial dipole (ICD DX; BIOTRONIK SE & Co, Berlin, Germany) was developed showing reliable atrial sensing performance without the need of an additional lead 8,9 …”

Section: Introductionmentioning

confidence: 99%

The role of atrial sensing for new‐onset atrial arrhythmias diagnosis and management in single‐chamber implantable cardioverter‐defibrillator recipients: Results from the THINGS registry

Biffi

Iori²,

Maria

et al. 2020

Cardiovasc electrophysiol

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Introduction Atrial tachycardia/fibrillation (AT/AF) episodes are common in implantable cardioverter‐defibrillator (ICD) recipients and can be undetected by standard single‐chamber devices. This study aims to explore whether a single‐lead ICD with an atrial dipole (ICD DX; BIOTRONIK SE & Co, Berlin, Germany) could improve the AT/AF diagnosis and management as compared to standard ICD (ICD VR). Methods and Results We selected patients without AT/AF history from the THINGS registry which included consecutive patients implanted with ICD for standard indications. The ICD VR and the ICD DX groups included 236 (62.8%) and 140 (37.2%) patients, respectively, and had no significant differences in baseline characteristics. During a median follow‐up of 27 months, there were 7 AT/AF diagnoses in the ICD VR and 18 in the ICD DX group. The 2‐year incidence of AT/AF diagnosis was 3.6% (95% confidence interval [CI]: 1.6%‐9.6%) for the ICD VR and 11.4% (95% CI: 6.8%‐18.9%) for the ICD DX group (adjusted hazard ratio [HR]: 3.85 [95% CI: 1.58‐9.41]; P = .003). Initiation of oral anticoagulation (OAC) due to AT/AF diagnosis was reported in 15 patients. The 2‐year incidence of OAC onset was 3.6% (95% CI: 1.6%‐7.8%) for the ICD VR and 6.3% (95% CI: 3.0%‐12.7%) for ICD DX group (adjusted HR: 1.99 [95% CI: 0.72‐5.56]; P = .184). Conclusion We observed that atrial sensing capability in single‐chamber ICD patients without evidence of atrial arrhythmias at implant is associated with a greater likelihood of detecting AT/AF episodes. The management of these diagnosed arrhythmias often led to clinical interventions, mainly represented by initiation of OAC therapy.

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“…In Pacing and Clinical Electrophysiology we have read with great interest the article by Worden et al. on long‐term stability and reliability of atrial sensing in Biotronik's implantable cardioverter defibrillator (ICD) DX system . The data on that topic are still very limited.…”

mentioning

confidence: 99%

How to Achieve Good Atrial Sensing in DX ICDs?

Michalak

Cacko

Grabowski

2017

Pacing Clinical Electrophis

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Long‐Term Stability and Clinical Utility of Amplified Atrial Electrograms in a Single‐Lead ICD System with Floating Atrial Electrodes

Abstract: The single-lead ICD system using a floating atrial dipole provides reliable recording of atrial signals during sinus rhythm and arrhythmias. Our data suggest that the system may offer diagnostic advantages of a dual-chamber device without potential risks of an additional atrial lead.

Cited by 16 publications

References 25 publications

Subclinical atrial fibrillation detection with a floating atrial sensing dipole in single lead implantable cardioverter‐defibrillator systems: Results of the SENSE trial

Subclinical atrial fibrillation detection with a floating atrial sensing dipole in single lead implantable cardioverter‐defibrillator systems: Results of the SENSE trial

The role of atrial sensing for new‐onset atrial arrhythmias diagnosis and management in single‐chamber implantable cardioverter‐defibrillator recipients: Results from the THINGS registry

How to Achieve Good Atrial Sensing in DX ICDs?

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