Incidence and Significance of Far-Field R Wave Sensing in a VDD-Implantable Cardioverter Defibrillator

Background: A VDD‐implantable cardioverter‐defibrillator (ICD) provides atrioventricular (AV) synchronous stimulation when necessary and incorporates the advantages of dual chamber arrhythmia discrimination algorithms both at potentially lower costs and less periprocedural complications than a DDD‐I...

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Published in:Pacing and clinical electrophysiology 2007-03, Vol.30 (3), p.395-403, Article 395
Main Authors: EBERHARDT, FRANK, SCHUCHERT, ANDREAS, SCHMITZ, DIETMAR, ZERM, THOMAS, MITZENHEIM, SABINE, WIEGAND, UWE KH
Format: Article
Language:English
Subjects:
atrial sensing
clinical trials
defibrillation-ICD
detection algorithm
Diagnosis, Computer-Assisted - methods
Electrocardiography - methods
far-field R waves
Germany - epidemiology
Humans
implantable cardioverter defibrillator
inappropriate therapy
Incidence
Male
Middle Aged
new technology
pacing
Reproducibility of Results
Sensitivity and Specificity
Tachycardia, Ventricular - diagnosis
Tachycardia, Ventricular - epidemiology
Tachycardia, Ventricular - prevention & control
Therapy, Computer-Assisted - methods
Treatment Outcome
VDD-lead
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Summary:Background: A VDD‐implantable cardioverter‐defibrillator (ICD) provides atrioventricular (AV) synchronous stimulation when necessary and incorporates the advantages of dual chamber arrhythmia discrimination algorithms both at potentially lower costs and less periprocedural complications than a DDD‐ICD system. A prerequisite for correct dual chamber ICD function is reliable atrial sensing. Methods: We evaluated atrial near‐ and ventricular far‐field sensing and its impact on the dual‐chamber detection algorithm in 106 patients with a single‐lead VDD‐ICD during a 12‐month follow‐up period. Results: Six hundred and thirty‐nine follow‐ups were included. Mean near‐field amplitude was 3.82 ± 1.76 mV; mean far‐field amplitude was 0.31 ± 0.15 mV. 46% of patients had far‐fields >0.35 mV and 35% of patients showed atrial EGM markers corresponding to a ventricular far‐field in at least one follow‐up. Six hundred and forty‐five tachycardia episodes were evaluated. Due to far‐field sensing, three of 66 episodes (4.5%) of sinus tachycardia were misclassified as ventricular tachycardia (VT), leading to antitachycardia therapies. Delayed detection of VT was seen in a 12 of 323 episodes (3.7%) in five of 62 patients (8%) having VT events (delay 6.4 ± 6.0 seconds (range 2–24 seconds)). Stable far‐field amplitudes
ISSN:0147-8389
1540-8159
DOI:10.1111/j.1540-8159.2007.00681.x