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. 2024 Dec 1;11(12):386.
doi: 10.3390/jcdd11120386.

Arrhythmia Detection in Atrioventricular, Single-Lead, Floating Atrial Dipole ICD Systems Compared with Conventional Single- and Dual-Chamber Defibrillators

Flora Diana Gausz  1 , Kom Nangob Manuela Lena  1   2 , Paul Emmanuel Gedeon  1   3 , Marton Miklos  1 , Attila Benak  1 , Gabor Bencsik  1 , Attila Makai  1 , Dora Kranyak  1 , Rita Beata Gagyi  1 , Robert Pap  1 , Laszlo Saghy  1 , Tamas Szili-Torok  1 , Mate Vamos  1
Affiliations

Arrhythmia Detection in Atrioventricular, Single-Lead, Floating Atrial Dipole ICD Systems Compared with Conventional Single- and Dual-Chamber Defibrillators

Flora Diana Gausz et al. J Cardiovasc Dev Dis. .

Abstract

Background: An atrioventricular defibrillator system with a floating atrial dipole (VDD ICD) can provide atrial sensing by a single lead. Our aim was to compare the arrhythmia detection efficacy of VDD ICDs with conventional single- (VVI) and dual-chamber (DDD) defibrillators.

Methods: Data from consecutive patients undergoing ICD implantation were retrospectively analyzed. The primary endpoint was the incidence of device-detected, new-onset atrial arrhythmias, while secondary endpoints were sensing parameters, complication rates, incidence of appropriate/inappropriate ICD therapy, arrhythmic/heart failure-related hospitalizations, and all-cause mortality.

Results: A total of 256 patients (mean age 64 ± 12 years, male 75%, primary prophylaxis 28%, mean follow-up 3.7 ± 2.4 years) were included (VVI: 93, VDD: 94, DDD: 69). Atrial arrhythmia episodes were detected more frequently by VDD systems compared to VVI ICDs (aHR 7.087; 95% CI 2.371-21.183; p < 0.001), and at a rate similar to that of DDD ICDs (aHR 1.781; 95% CI 0.737-4.301; p = 0.200). The rate of inappropriate shocks was not different among the three ICD systems.

Conclusion: VDD devices revealed an advantage in atrial arrhythmia detection compared to VVI ICDs and were non-inferior to DDD systems. Their main indication may be closer monitoring in high-risk patients with atrial arrhythmias to help therapy optimization and not the improvement of tachycardia discrimination.

Keywords: ICD; VDD; atrial arrythmia detection; floating atrial sensing dipole; implantable cardioverter defibrillator; tachycardia discrimination.

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Conflict of interest statement

T.S.-T. reports educational activity/advisory relationship with Biotronik, and until 2022, he was in educational/advisory/product development relationships with Ablacon Inc., Abbott, Acutus Medical, Biosense Webster, and Stereotaxis. M.V. reports educational activity and advisory relationship with Biotronik, and educational activity on behalf of KRKA, Medtronic, Novo Nordisk, and Pfizer. All other authors have nothing to disclose.

Figures

Figure 1
Figure 1
(A) Time to first device-detected atrial arrhythmia—VVI vs. VDD. (B) Time to first device detected atrial arrhythmia—VDD vs. DDD. aHR: adjusted hazard ratio.
Figure 1
Figure 1
(A) Time to first device-detected atrial arrhythmia—VVI vs. VDD. (B) Time to first device detected atrial arrhythmia—VDD vs. DDD. aHR: adjusted hazard ratio.
Figure 2
Figure 2
Atrial sensing in VDD vs. DDD ICDs at 6th month. * and formula image: it represents an outliner value.
Figure 3
Figure 3
All-cause mortality in all groups.
See this image and copyright information in PMC

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