S-114
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Does dual-chamber sensing
improve implantable cardioverter-defibrillator detection?
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Werner Jung, Christian Wolpert,
Susanne Spehl, Bahman Esmailzadeh*, Christian Schneider*, Thorsten Lewalter, Berndt
Lüderitz.
Departments of Medicine-Cardiology and *Cardiovascular Surgery, University of
Bonn, Bonn, Germany
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Introduction
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Single-chamber ventricular defibrillator implantation
has been shown to be an effective and safe treatment for patients with malignant
ventricular tachyarrhythmias and to significantly reduce the incidence of sudden cardiac
death. However, the high incidence of inappropriate implantable cardioverter defibrillator
(ICD) therapy due to supraventricular tachycardias (SVT) is a major challenge and has been
reported to affect up to 25% of patients1,2. Enhanced
detection criteria such as rate stability, sudden onset and morphology assessment improve
the specificity of ICD therapy, but may place the patient at risk of underdetection of
ventricular tachycardia (VT)3-7. Recently, it has been
shown that algorithms using dual-chamber sensing may significantly improve differentiation
between SVT and VT8-10. Another beneficial effect of
dual-chamber ICD may be the opportunity not only to sense in the atrium, but also to pace
in this chamber. Although the beneficial effects of DDD pacing are well known, most of the
currently available ICDs provide only fixed ventricular antibradycardia pacing. In a
recent retrospective study the need for antibradycardia pacing was analyzed in a
consecutive series of 139 ICD patients11. The findings
of this report indicate that up to 18% of the ICD patients are in need of antibradycardia
pacing, with up to 80% of these patients having an indication for DDD pacing. These
results are supported by an independent analysis from our center12.
This report describes the early clinical experience with an ICD capable of dual-chamber
detection for arrhythmia diagnosis and dual-chamber pacing function.
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